Many immunosuppressive drugs are prescribed as twice-daily dosing. A simplified once-daily dosing of immunosuppressive drug regimen may improve medication adherence. We investigated medication ...adherence of simplified once-daily immunosuppressive regimen consisting of extended-release tacrolimus, sirolimus, and corticosteroids along with the efficacy and safety of this regimen.
This study was a prospective, multicenter, controlled and cohort trial. Stable kidney transplant recipients who had received transplantation at least 3 months before the study enrollment were eligible for the study. Participants were required to fill-out the self-reported immunosuppressant therapy barrier scale (ITBS) questionnaire before and after the conversion. Other clinical laboratory parameters and adverse events were evaluated until 6 months post-conversion.
A total of 160 kidney recipients comprised the intention-to-treat population. The mean total ITBS score was 19.5 ± 4.0 at pre-conversion and 6 months after converting, the mean total ITBS score was 16.6 ± 3.6 (p < 0.001). Particularly, the ITBS scores of 4 questions related to the frequency of medication dosing were significantly different between pre-conversion and post-conversion. Only 1 patient (0.62%) was diagnosed as biopsy-confirmed acute rejection in the study period. There was no significant change in the mean estimated glomerular filtration rate after the conversion. Overall 95 patients (59.4%) had an adverse event and 28 patients (17.5%) had a serious adverse event. No graft loss and 1 death were reported.
Medication adherence after the conversion to the once-daily immunosuppressive regimen was significantly improved with no additional risks of efficacy failure or adverse events.
Abstract Purpose Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. Materials and Methods This retrospective ...cross-sectional study included patients with symptomatic (heart rate HR ≤ 50/min with dyspnea, chest pain, altered mentality, dizziness/syncope/presyncope, general weakness, oliguria, or shock) or extreme (HR ≤ 40/min) bradycardia at an emergency department for 46 months. Risk factors for severe hyperkalemia were chosen by multiple logistic regression analysis from history (sex, age, comorbidities, and medications), vital signs, and electrocardiography (ECG; maximum precordial T-wave amplitude, PR, and QRS intervals). The derived diagnostic index was validated using bootstrapping method. Results Among the 169 participants enrolled, 87 (51.5%) were female. The mean (SD) age was 71.2 (12.5) years. Thirty-six (21.3%) had severe hyperkalemia. The diagnostic summed “maximum precordial T ≥ 8.5 mV (2),” “atrial fibrillation/junctional bradycardia (1),” “HR ≤ 42/min (1),” “diltiazem medication (2),” and “diabetes mellitus (1).” The C -statistics were 0.86 (0.80-0.93) and were validated. For scores of 4 or higher, sensitivity was 0.50, specificity was 0.92, and positive likelihood ratio was 6.02. The “ECG-only index,” which sums the 3 ECG findings, had a sensitivity of 0.50, specificity of 0.90, and likelihood ratio (+) of 5.10 for scores of 3 or higher. Conclusions Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history.
•Numerical and experimental studies of CO2 critical flow for turbo-machinery seal.•Verification of the CO2 critical flow model based on the isentropic flow.•Modification of the Hodkinson’s and ...Vermes' equations for CO2 leakage analysis.•Comparison of experimental data with choked flow and labyrinth seal flow equations.
Supercritical CO2 (S-CO2) has the potential to be used as the working fluid in a power cycle since S-CO2 shows a density value high as its liquid phase while the viscosity value remains closer to its gaseous phase. Thus, it requires much less work to compress due to its low compressibility as well as relatively small flow resistance. However, the S-CO2 leakage flow from turbo-machinery via seal becomes one of the important issues since not only it influences the cycle efficiency due to parasitic loss but also it is important for evaluating the system safety under various operating conditions.
In this paper, the gap effect, which is studied by changing the diameter of an orifice, cavity length effect, and the number of tooth effect in a simulated labyrinth seal geometry nozzle are presented. Experimental results under various conditions including not only single phase flow but also two phase flow conditions are presented.
We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under ...tacrolimus-based immunosuppression regimen during 1 year after transplantation.
This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index IGI) and resistance (homeostatic model assessment for insulin resistance HOMA-IR) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM.
PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM.
In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation.
This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to ...medical disputes or claims on medical professional liability.
Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs.
Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals.
The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.
The graphic DRAM standard GDDR6 is developed to overcome the limitation of previous standards GDDR5/5X for achieving high-speed operation. This paper introduces 16-Gb GDDR6 DRAM with a per-bit ...trainable single-ended decision feedback equalizer (DFE), a reference impedance (ZQ)-coded transmitter, and a phase-locked loop (PLL)-less clocking to overcome I/O speed limitation by the DRAM process. Furthermore, this paper optimizes clock- and power-domain crossings and adopts split-die architecture to improve signal integrity (SI). This GDDR6 operates 16 Gb/s/pin with 1.15 V and achieves 18 Gb/s/pin with 1.35 V in the DRAM process.
For low-power 8.5-Gbps operation, 4th-generation 10-nm 16-Gb LPDDR5x DRAM I/O circuits and control methods are proposed in this article. The proposed I/O improves signal integrity (SI) and power ...integrity (PI) by using a self-pre-emphasized stacked driver in transmitter (Tx), a supply voltage insensitive data receiver (Rx), and an optimized clock tree in write clock (WCK) clock paths. The measured eye widths of Tx and Rx, which are the indicators of the SI/PI, are 0.66 unit interval (UI) and 0.57 UI at 8.5 Gbps, respectively. Also, the measured power consumption is reduced by 20.0% compared to the previous LPDDR5 SDRAM product.
Here, we report a facile and efficient sequential n-doping method to increase the device performance of planar-type organic/inorganic perovskite solar cells. Compared to the pristine PCBM-based ...electron transport layer (ETL), power conversion efficiencies of cells with a doped ETL are dramatically enhanced up to 12.53%.
This study was conducted to examine the effect of plant growth regulators on the rooting and growth of Rhododendron micranthum Turcz., a rare plant in South Korea. Indole-3-butyric acid (IBA) 150, ...250, 350 mg·L−1 and α-naphthaleneacetic acid (NAA) 50, 150, 250 mg·L−1 treatment groups were established and cutting was performed in a commercial growth medium in March 2021 with 3 replications of 10 plants per group. After 70 days, the longest initial root growth was observed under the NAA 150 and 250 mg·L−1 treatments. Moreover, the number of roots and percentage of rooting were slightly higher in NAA 150 and 250 mg·L−1, indicating that these treatments were more effective in promoting plant growth. The above-ground part of plants treated with NAA 150 and 250 mg·L−1 had a taller plant height, longer and wider leaves, and a greater number of leaves compared to other groups. Accordingly, the survival rate of plants treated with NAA 150 and 250 mg·L−1 was higher than 80%, suggesting well-established roots and excellent above-ground growth. Therefore, treatment with growth regulator NAA at 150 and 250 mg·L−1 is considered beneficial for the cutting of R. micranthum Turcz.
PDF
