Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Met...Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.展开更多
Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),...Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.展开更多
This paper proposes a channel allocation scheme for multimedia wireless networks,in which a twolayer macro-cell or micro-cell architecture is considered.Macro-cells are used to access high-mobility services;while micr...This paper proposes a channel allocation scheme for multimedia wireless networks,in which a twolayer macro-cell or micro-cell architecture is considered.Macro-cells are used to access high-mobility services;while micro-cells,which are overlaid by the macro-cells,are used to cater low-mobility services.To analyze the scheme,a multidimensional Markov traffic model is firstly developed,in which traffic characteristic of two special periods of time is considered.And then,a pre-emptive channel-borrowing scheme combined with trafficoverflowing strategy for multimedia(voice,video or data) networks is proposed,in which handoff requests can not only borrow channels from adjacent homogenous cells,but also be overflowed to heterogeneous cells.Priority strategies are also dedicated to high-mobility services for they can pre-empt channels being used by low-mobility services in macro-cells.To meet the high quality of service(QoS) requirements of video services and increase the channel utilization ratio,video services can be transformed between real-time services and non-real-time services as necessary.Simulation results show that our schemes can decrease the blocking probabilities and improve the channel utilization.展开更多
BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est...BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.展开更多
A multimedia channel allocation scheme is proposed and studied in terms of the connection-level QoS.A new traffic model based on multidimensional Markov chain is developed considering the traffic characteristic of two...A multimedia channel allocation scheme is proposed and studied in terms of the connection-level QoS.A new traffic model based on multidimensional Markov chain is developed considering the traffic characteristic of two special periods of time.And the pre-emptive priority strategies are used to classify real-time services and non-real-time services.Real-time service is given higher priority for its allowance to pre-empt channels used by non-real-time service.Considering the mobility of persons in a day,which affects the mobile user's density,the simulation was conducted involving the two pre-emptive priority strategies.The result of some comparisons shows the feasibility of the proposed scheme.展开更多
A channel allocation scheme for hierarchical wireless networks was proposed in terms of the connection-level quality of service. The channel allocation scheme was analyzed using both horizontal channel borrowing and v...A channel allocation scheme for hierarchical wireless networks was proposed in terms of the connection-level quality of service. The channel allocation scheme was analyzed using both horizontal channel borrowing and vertical traffic overflowing. Pre-emptive priority strategies are used to classify real-time services and non-real-time services, real-time service is given higher priority for it is allowed to pre-empt channels used by non-real-time service. Some channel borrowing thresholds and acceptance ratios are used to avoid channel locking or dynamic power control, which can also be dynamically adjusted according to network load. Simulation results show that the proposed schemes can improve the system performance.展开更多
With a globally estimated 58 million people affected by,chronic hepatitis C virus(HCV)infection still represents a hard challenge for scientific community.A chronic course can occur among patients with a weak innate a...With a globally estimated 58 million people affected by,chronic hepatitis C virus(HCV)infection still represents a hard challenge for scientific community.A chronic course can occur among patients with a weak innate ad adaptive response with cirrhosis and malignancies as main consequences.Oncologic patients undergoing chemotherapy represent a special immunocompromised population predisposed to HCV reactivation(HCVr)with undesirable changes in cancer treatment and outcome.Aim of the study highlight the possibility of HCVr in oncologic population eligible to chemotherapy and its threatening consequences on cancer treatment;underline the importance of HCV screening before oncologic therapy and the utility of direct aging antivirals(DAAs).A comprehensive overview of scientific literature has been made.Terms searched in PubMed were:“HCV reactivation in oncologic setting”“HCV screening”,“second generation DAAs”.Pharmacokinetic and Pharmacodynamics characteristics of DAAs are reported,along with drug-drug interactions among chemotherapeutic drug classes regimens and DAAs.Clinical trials conducted among oncologic adults with HCV infection eligible to both chemotherapy and DAAs were analyzed.Viral eradication with DAAs in oncologic patients affected by HCV infection is safe and helps liver recovery,allowing the initiation of cancer treatment no compromising its course and success.展开更多
Aims There is much evidence that plant competition below ground is size symmetric,i.e.that competing plants share contested resources in proportion to their sizes.Several researchers have hypothesized that a patchy di...Aims There is much evidence that plant competition below ground is size symmetric,i.e.that competing plants share contested resources in proportion to their sizes.Several researchers have hypothesized that a patchy distribution of soil nutrients could result in size-asymmetric root competition.We tested this hypothesis.Methods In a greenhouse experiment,Triticum aestivum(wheat)individ-uals of different initial sizes were grown alone or with below-ground competition from one neighbour,in 1 m tall,narrow containers in a nitrogen-poor field soil with(i)no added nitro-gen,(ii)nitrogen fertilizer mixed into the upper 50 cm,and(iii)the same amount of fertilizer mixed into a 20-30 cm deep layer.We measured total leaf length throughout the experiment,and above-ground biomass and nitrogen concentration at harvest.We also measured root depth and frequency over time in a subset of containers.Important Findings Competing plants were half the size of non-competing plants,meaning that root competition was very strong.Root competition was size-asym-metric to some degree in all soil treatments.Neighbours larger than the target plant showed a greater per-unit-size effect on target growth than neighbours smaller than the target.Size variation increased over time for competing individuals,but decreased for non-competing pairs.Contrary to expectations,the presence of a high-nutrient patch reduced the strength and size asymmetry of competition temporarily.Size asym-metry in poor,deep soils may result from directionality in resource interception as roots compete for limited nutrients by growing deeper into soil layers that have not yet been exploited.Root competition can be size asymmetric,but not to the same degree as competition for light.展开更多
基金The National Natural Science Foundation of China(Project No.:82172036)Undergraduate teaching quality and teaching reform cultivation project of the First Affiliated Hospital of Sun Yat-sen University in 2023(Project No.P12220011-230106)。
文摘Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.
文摘Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.
基金the National Natural Science Foundation of China (No.60802058)the Leading Academic Discipline Project of Shanghai Municipal Education Commission (No.J51801)
文摘This paper proposes a channel allocation scheme for multimedia wireless networks,in which a twolayer macro-cell or micro-cell architecture is considered.Macro-cells are used to access high-mobility services;while micro-cells,which are overlaid by the macro-cells,are used to cater low-mobility services.To analyze the scheme,a multidimensional Markov traffic model is firstly developed,in which traffic characteristic of two special periods of time is considered.And then,a pre-emptive channel-borrowing scheme combined with trafficoverflowing strategy for multimedia(voice,video or data) networks is proposed,in which handoff requests can not only borrow channels from adjacent homogenous cells,but also be overflowed to heterogeneous cells.Priority strategies are also dedicated to high-mobility services for they can pre-empt channels being used by low-mobility services in macro-cells.To meet the high quality of service(QoS) requirements of video services and increase the channel utilization ratio,video services can be transformed between real-time services and non-real-time services as necessary.Simulation results show that our schemes can decrease the blocking probabilities and improve the channel utilization.
文摘BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.
基金the National Natural Science Foundation of China (Grant No. 60372076)
文摘A multimedia channel allocation scheme is proposed and studied in terms of the connection-level QoS.A new traffic model based on multidimensional Markov chain is developed considering the traffic characteristic of two special periods of time.And the pre-emptive priority strategies are used to classify real-time services and non-real-time services.Real-time service is given higher priority for its allowance to pre-empt channels used by non-real-time service.Considering the mobility of persons in a day,which affects the mobile user's density,the simulation was conducted involving the two pre-emptive priority strategies.The result of some comparisons shows the feasibility of the proposed scheme.
基金The National Natural Science Foundation of China (No. 60372076)
文摘A channel allocation scheme for hierarchical wireless networks was proposed in terms of the connection-level quality of service. The channel allocation scheme was analyzed using both horizontal channel borrowing and vertical traffic overflowing. Pre-emptive priority strategies are used to classify real-time services and non-real-time services, real-time service is given higher priority for it is allowed to pre-empt channels used by non-real-time service. Some channel borrowing thresholds and acceptance ratios are used to avoid channel locking or dynamic power control, which can also be dynamically adjusted according to network load. Simulation results show that the proposed schemes can improve the system performance.
文摘With a globally estimated 58 million people affected by,chronic hepatitis C virus(HCV)infection still represents a hard challenge for scientific community.A chronic course can occur among patients with a weak innate ad adaptive response with cirrhosis and malignancies as main consequences.Oncologic patients undergoing chemotherapy represent a special immunocompromised population predisposed to HCV reactivation(HCVr)with undesirable changes in cancer treatment and outcome.Aim of the study highlight the possibility of HCVr in oncologic population eligible to chemotherapy and its threatening consequences on cancer treatment;underline the importance of HCV screening before oncologic therapy and the utility of direct aging antivirals(DAAs).A comprehensive overview of scientific literature has been made.Terms searched in PubMed were:“HCV reactivation in oncologic setting”“HCV screening”,“second generation DAAs”.Pharmacokinetic and Pharmacodynamics characteristics of DAAs are reported,along with drug-drug interactions among chemotherapeutic drug classes regimens and DAAs.Clinical trials conducted among oncologic adults with HCV infection eligible to both chemotherapy and DAAs were analyzed.Viral eradication with DAAs in oncologic patients affected by HCV infection is safe and helps liver recovery,allowing the initiation of cancer treatment no compromising its course and success.
文摘Aims There is much evidence that plant competition below ground is size symmetric,i.e.that competing plants share contested resources in proportion to their sizes.Several researchers have hypothesized that a patchy distribution of soil nutrients could result in size-asymmetric root competition.We tested this hypothesis.Methods In a greenhouse experiment,Triticum aestivum(wheat)individ-uals of different initial sizes were grown alone or with below-ground competition from one neighbour,in 1 m tall,narrow containers in a nitrogen-poor field soil with(i)no added nitro-gen,(ii)nitrogen fertilizer mixed into the upper 50 cm,and(iii)the same amount of fertilizer mixed into a 20-30 cm deep layer.We measured total leaf length throughout the experiment,and above-ground biomass and nitrogen concentration at harvest.We also measured root depth and frequency over time in a subset of containers.Important Findings Competing plants were half the size of non-competing plants,meaning that root competition was very strong.Root competition was size-asym-metric to some degree in all soil treatments.Neighbours larger than the target plant showed a greater per-unit-size effect on target growth than neighbours smaller than the target.Size variation increased over time for competing individuals,but decreased for non-competing pairs.Contrary to expectations,the presence of a high-nutrient patch reduced the strength and size asymmetry of competition temporarily.Size asym-metry in poor,deep soils may result from directionality in resource interception as roots compete for limited nutrients by growing deeper into soil layers that have not yet been exploited.Root competition can be size asymmetric,but not to the same degree as competition for light.
