AIM: To monitor the concentration of tacrolimus in whole blood in liver transplant recipients and establish an optimal therapeutic window of tacrolimus, in order to provide information for rational usage in clinic. METHODS: The whole blood concentrations of tacrolimus were measured by ELISA. The levels of tacrolimus in 1190 samples from 138 liver transplant recipients were compared and studied. RESULTS: The whole blood concentration of tacrolimus is gradually decreased with time after operation. The optimal therapeutic window of tacrolimus for liver transplant recipients was 8-15 ?g?L -1 within 1 month after operation, 6-12 ?g?L -1 from the 2nd to 3rd months, 5-10 ?g?L -1 from the 4th to 6th months and 3-8 ?g?L -1 after 6 months, respectively. CONCLUSION: It is necessary to routinely monitor blood concentration of tacrolimus. The satisfying therapeutic effects will be obtained if dosage regimens will be individualized according to optimal therapeutic window.

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.

Objective: To investigate the application value of CTDI_vol and size-specific dose estimate(SSDE) in evaluating the radiation dose of adult chest CT. Methods: A retrospective analysis was made on the CTDI_voland SSDE of 128 patients who underwent chest CT scanning in the First Affiliated Hospital of Zhejiang Chinese Medical University from March to April 2017 and all images are adequate for diagnosis. The subjects were divided into three groups according to body mass index (BMI): Group A, 38 cases with 16≤BMI<21.1 kg/m²; Group B, 53 cases with 21.1≤BMI<23.9 kg/m²; Group C, 37 cases with 23.9≤BMI<34.1 kg/m². The diameters of anterior-posterior (AP) and left-right (LAT) of each patient were measured in the slice of nipple level, and CTDI_vol, effective diameter (ED), conversion factor (f_size) and SSDE of each patient were recorded and calculated. Meanwhile, the differences between CTDI_vol and SSDE in different BMI groups were compared. Results: SSDE of each group was higher than CTDI_vol, and increased by 50.13%, 42.83% and 33.68% in group A, B and C, respectively. There were significant differences in radiation dose between CTDI_vol and SSDE in the three groups (t=-48.873, -57.001, -32.651, P<0.05). There were significant differences in ED, f_size, CTDI_vol and SSDE among the three groups (F=51.456, 47.749, 113.916, 106.449, P<0.05). Conclusions SSDE can evaluate the radiation dose absorbed by patients with different body types in chest CT, while CTDI_vol underestimated the radiation dose.The lower BMI, the greater the underestimated dose value, the more radiation dose absorbed.

Many efforts have been made to understand excitotoxicity and develop neuroprotectants for the therapy of ischemic stroke. The narrow treatment time window is still to be solved. Given that the ischemic core expanded over days, treatment with an extended time window is anticipated. Bestrophin 1 (BEST1) belongs to a bestrophin family of calcium-activated chloride channels. We revealed an increase in neuronal BEST1 expression and function within the peri-infarct from 8 to 48 h after ischemic stroke in mice. Interfering the protein expression or inhibiting the channel function of BEST1 by genetic manipulation displayed neuroprotective effects and improved motor functional deficits. Using electrophysiological recordings, we demonstrated that extrasynaptic glutamate release through BEST1 channel resulted in delayed excitotoxicity. Finally, we confirmed the therapeutic efficacy of pharmacological inhibition of BEST1 during 6-72 h post-ischemia in rodents. This delayed treatment prevented the expansion of infarct volume and the exacerbation of neurological functions. Our study identifies the glutamate-releasing BEST1 channel as a potential therapeutic target against ischemic stroke with a wide time window.