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加拿大新生儿重症监护病房早产儿机械通气期间麻醉镇痛药和镇静剂应用趋势的回顾性研究(英文)

中国当代儿科杂志 2018年第1期20卷 5-11页

作者： jennifer m Toye Lucia mirea Junmin Yang Koravangattu Sankaran 刘玲 Division of Neonatology Department of Pediatrics University of Alberta maternal-Infant care Research centre Mount Sinai Hospital Division of Neonatology Department of Pediatrics University of Saskatchewan 贵州省妇幼保健院

早产儿气管插管有创机械通气可引起患儿不适,但是否导致疼痛仍存有争议。已发表的荟萃分析显示,早产儿机械通气期间应用麻醉镇痛药并未减轻患儿疼痛。因此,不推荐对新生儿重症监护病房(NIcU)机械通气早产儿常规应用麻醉镇痛药和镇静剂... 详细信息

早产儿气管插管有创机械通气可引起患儿不适,但是否导致疼痛仍存有争议。已发表的荟萃分析显示,早产儿机械通气期间应用麻醉镇痛药并未减轻患儿疼痛。因此,不推荐对新生儿重症监护病房(NIcU)机械通气早产儿常规应用麻醉镇痛药和镇静剂。假设目前加拿大NIcU早产儿机械通气过程中麻醉镇痛药和镇静剂的使用呈下降趋势。该研究回顾性分析了2004~2009年间出生胎龄24 h的早产儿接受镇静剂和麻醉镇痛药使用的趋势。入院时处于濒死状态、先天畸形、需要外科手术(除外眼科激光手术)、坏死性小肠结肠炎、胸腔置管引流或孕母有麻醉药品滥用史的早产儿不纳入该研究。根据早产儿是否接受麻醉镇痛药(如吗啡、芬太尼、美沙酮、舒芬太尼、杜冷丁、阿芬太尼和可待因等)或镇静剂(如水合氯醛、咪达唑仑、劳拉西泮、苯巴比妥、戊巴比妥、氯胺酮和丙泊酚)以及早产儿胎龄(胎龄cochrane-Armitage趋势分析方法评估早产儿麻醉镇痛药和镇静剂的应用趋势。5 638名早产儿符合纳入标准,其中2 169名(38.5%)应用了麻醉镇痛药,897名(15.9%)应用了镇静剂,722名(12.8%)同时接受了麻醉镇痛药和镇静剂治疗。最常用的麻醉镇痛药是吗啡(62.2%)和芬太尼(63.8%);最常用的镇静剂是苯巴比妥(44.9%)和水合氯醛(44.2%)。镇静剂的使用在胎龄cU患者出院后仍记得在IcU住院期间的感受,并承认经历气管插管和有创机械通气的过程是很痛苦的。然而,现实中很难区分患者的疼痛感受是由于IcU住院期间的有创通气引起,抑或是因在IcU住院期间躯体的疾病或其他因素所致。同理,对于住院期间早产儿皮质醇水平的升高,是由于疾病的严重程度或因机械通气引起的疼痛和/或应激所致同样很难鉴别。查阅大量文献发现,有创机械通气期间麻醉镇痛药或镇静剂的使用并没有减轻患者的痛苦,然而药物潜在的不良反应却令人担忧。但目前在NIcU住院早产儿有创机械通气过程中,给患儿应用麻醉镇痛药或镇静剂仍然是很普遍的现象。该研究数据来自于加拿大新生儿协作网,该协作网覆盖了加拿大全国范围内30家三甲医院。样本量大,数据收集方法有效、可靠,这是该研究的主要优势。其主要不足在于机械通气早产儿没有明确的应用镇静或麻醉镇痛药物的指征,一些分析只能是从现有的数据外推。此外,该研究早产儿上机过程中其他非药物镇痛替代措施的应用,也可能会高估或低估麻醉镇痛药/镇静剂的作用。其他的影响因素还包括:缺乏疾病的严重度、上机时间以及麻醉镇痛/镇静药物应用的评估依据,以及研究资料未能收集到上机过程中环境因素或非药物干预措施减轻患儿不适/应激/疼痛的数据,所以不能对机械通气过程中麻醉镇痛/镇静剂使用趋势做出更为深入的解释。目前,令人担忧的是,机械通气过程中接受阿片类药物镇痛的早产儿是受药物不良反应影响的高风险人群,而这些药物在这个群体中的应用又呈现增加趋势;但如果对NIcU住院早产儿经历的疼痛和应激不予管理,也会对其神经系统发育产生近期和远期的不良影响。因此,在临床实践中,必须对早产儿的疼痛采用量表进行评估,根据循证医学指南指导麻醉镇痛药和镇静剂的应用,从患儿舒适的角度制定治疗和护理方案。尽管麻醉镇痛药和镇静剂可能的潜在不良反应的否定证据也逐渐增加,但加拿大新生儿医师仍然担忧机械通气早产儿连续应用麻醉镇痛药和镇静剂以及肌松剂的不良反应。用非药物的措施减轻机械通气患儿的不适/应激/疼痛的研究日益增多并受到广泛的关注,且有巨大的应用前景。一些在研的、旨在减轻早产儿上机过程中经历的中等程度的疼痛/应激、同时又尽可能限制药物不良反应并考虑到对患儿远期神经发育影响药物的研究已经得到批准。另外,住院新生儿经历的慢性疼痛也引起了许多学者的重视,且也成为一个新兴的研究热点,需要学者们开展更深入的研究。小结:加拿大NIcU胎龄cU早产儿机械通气期间麻醉镇痛药的使用并没有呈下降趋势,其原因尚需进一步深入研究。

关键词：麻醉镇痛药镇静剂机械通气趋势早产儿

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Reimagining large river management using the Resist-Accept-Direct(RAD)framework in the Upper mississippi River

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Ecological Processes 2023年第1期12卷 645-664页

作者： Nicole K.Ward Abigail J.Lynch Erik A.Beever Joshua Booker Kristen L.Bouska Holly Embke Jeffrey N.Houser John F.Kocik Joshua Kocik David J.Lawrence mary Grace Lemon Doug Limpinsel madeline R.magee Bryan m.maitland Owen mcKenna Andrew meier John m.morton Jeffrey D.muehlbauer Robert Newman Devon c.Oliver Heidi m.Rantala Greg G.Sass Aaron Shultz Laura m.Thompson jennifer L.Wilkening minnesota Department of Natural Resources Lake CityMN 55041USA U.S.Geological Survey National Climate Adaptation Science CenterRestonVA 22041USA U.S.Geological Survey Northern Rocky Mountain Science CenterBozemanMT 59715USA Department of Ecology Montana State UniversityBozemanMT 59715USA U.S.Fish and Wildlife Service National Wildlife Refuge SystemOak HarborOH 43449USA U.S.Geological Survey Upper Midwest Environmental Sciences CenterLa CrosseWI 54603USA U.S.Geological Survey Midwest Climate Adaptation Science CenterSt.PaulMN 55108USA NOAA NEFSc OronoME 04473USA University of Nebraska-Lincoln LincolnNE 68503USA National Park Service Climate Change Response ProgramFort CollinsCO 80525USA U.S.Fish and Wild-life Service National Wildlife Refuge SystemBloomingtonMN 55437USA Habitat conservation Division NOAAAlaska RegionAnchorageAK 99513USA Wisconsin Department of Natural Resources MadisonWI 53703USA Aquatic Sciences center Center for LimnologyUW-MadisonMadisonWI 53706USA U.S.Geological Survey Northern Prairie Wildlife Research Center and Midwest Climate Adaptation Science CenterJamestownND 58401USA U.S.Army corps of Engineers La CrescentMN 55947USA Alaska Wildlife Alliance AnchorageAK 99520USA U.S.Geological Survey Alaska Cooperative Fish and Wildlife Research UnitUniversity of Alaska FairbanksFairbanksAK 99775USA University of North Dakota Grand ForksND 58202USA minnesota Department of Natural Resources DuluthMN 55804USA Wisconsin Department of Natural Resources Boulder JunctionWI 54512USA Great Lakes Indian Fish and Wildlife commission(GLIFWc) OdanahWI 54861USA U.S.Geological Survey National Climate Adaptation Science Centerand School of Natural ResourcesUniversity of TennesseeKnoxvilleTN 37996USA U.S.Fish and Wildlife Service National Wildlife Refuge SystemFort CollinsCO 80526USA

Background Large-river decision-makers are charged with maintaining diverse ecosystem services through unprec-edented social-ecological transformations as climate change and other global stressors *** interconnected,dendritic habitats of rivers,which often demarcate jurisdictional boundaries,generate complex management ***,we explore how the Resist–Accept–Direct(RAD)framework may enhance large-river management by promoting coordinated and deliberate responses to social-ecological trajectories of *** RAD frame-work identifies the full decision space of potential management approaches,wherein managers may resist change to maintain historical conditions,accept change toward different conditions,or direct change to a specified future with novel *** the Upper mississippi River System,managers are facing social-ecological transformations from more frequent and extreme high-water *** illustrate how RAD-informed basin-,reach-,and site-scale decisions could:(1)provide cross-spatial scale framing;(2)open the entire decision space of potential management approaches;and(3)enhance coordinated inter-jurisdictional management in response to the trajectory of the Upper mississippi River *** The RAD framework helps identify plausible long-term trajectories in different reaches(or subbasins)of the river and how the associated social-ecological transformations could be managed by altering site-scale *** reach-scale objectives may reprioritize how,where,and when site conditions could be altered to contribute to the basin goal,given the basin’s plausible trajectories of change(e.g.,by coordinating action across sites to alter habitat connectivity,diversity,and redundancy in the river mosaic).conclusions When faced with long-term systemic transformations(e.g.,>50 years),the RAD framework helps explicitly consider whether or when the basin vision or goals may no longer be achievable,and direct options may open y

关键词： Ecosystem management Transformation Social-ecological system Anthropocene climate change Basin planning cross-scale interactions

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Bioproduced Proteins On Demand(Bio-POD)in hydrogels using Pichia pastoris

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Bioactive materials 2021年第8期6卷 2390-2399页

作者： Shuo-Fu Yuan Sierra m.Brooks Annalee W.Nguyen Wen-Ling Lin Trevor G.Johnston jennifer A.maynard Alshakim Nelson Hal S.Alper Institute for cellular and molecular Biology The University of Texas at AustinAustinTXUSA mcKetta Department of chemical Engineering The University of Texas at AustinAustinTXUSA Department of chemistry University of WashingtonBox 351700SeattleWAUSA

Traditional production of industrial and therapeutic proteins by eukaryotic cells typically requires large-scale fermentation *** a result,these systems are not easily portable or reusable for on-demand protein production *** this study,we employ Bioproduced Proteins On Demand(Bio-POD),a F127-bisurethane methacrylate hydrogel-based technique that immobilizes engineered Pichia pastoris for preservable,on-demand production and secretion of medium-and high-molecular weight proteins(in this case,SEAP,α-amylase,and anti-HER2).The gel samples containing encapsulated-yeast demonstrated sustained protein production and exhibited productivity immediately after lyophilization and *** hydrogel platform described here is the first hydrogel immobilization using a *** system to produce recombinant proteins of this *** results highlight the potential of this formulation to establish a cost-effective bioprocessing strategy for on-demand protein production.

关键词： Protein production Hydrogel Pichia pastoris Immobilization Lyophilization

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Response to osimertinib in a colorectal cancer patient with an EGFR T790m mutation: A case report

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1829-1834页

作者： Blake Buzard Lindsey Douglass Beth Gustafson jennifer Buckley marc Roth Lara Kujtan Dhruv Bansal cancer Institute St.Luke's HospitalKansasMO 64111United States Department of medical Oncology University of Missouri-Kansas CityKansasMO 64108United States Department of Hematology/Oncology St.Luke's Cancer InstituteKansasMO 64111United States

BAcKGROUND Although common in lung cancer,somatic epidermal growth factor receptor(EGFR)mutations are rarely found in colorectal cancer,occurring in approximately 3%of *** with anti-EGFR antibodies is commonplace,but EGFR tyrosine kinase inhibitors are not standard treatments in colorectal *** we report a case of sustained response to osimertinib in a colorectal cancer patient with an EGFR T790m mutation on cell-free DNA *** SUmmARY A 72-year old woman with a past medical history of post-polio syndrome confined to a wheelchair,scoliosis and hypothyroidism presented with metastatic sigmoid colon adenocarcinoma with hepatic *** generation sequencing revealed a RAS/RAF wild-type,microsatellite stable,PD-L1 negative *** in TP3 and APc were also identified,as well as EGFR ***-free DNA analysis revealed an EGFR T790m *** was unable to tolerate first-line treatment with panitumumab,5-fluorouracil and leucovorin,progressed on second-line treatment with trifluridine/tipiracil plus bevacizumab,and was unable to tolerate third-line treatment with *** was started on fourth-line treatment with off-label osimertinib,with clinical response–decrease in size of hepatic metastases and a pericardial *** remained on treatment with osimertinib for seven *** This case shows the benefit of multi-gene sequencing assays to identify potential therapeutic options in patients with refractory disease.

关键词： colorectal cancer Osimertinib Epidermal growth factor receptor T790m Precision oncology Tyrosine kinase inhibitor case report

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Hybrid de novo genome assembly of red gromwell(Lithospermum erythrorhizon)reveals evolutionary insight into shikonin biosynthesis

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Horticulture Research 2020年第1期7卷 1651-1665页

作者： Robert P.Auber Thiti Suttiyut Rachel m.mccoy manoj Ghaste Joseph W.crook Amanda L.Pendleton Joshua R.Widhalm jennifer H.Wisecaver Department of Biochemistry Purdue UniversityWest LafayetteIN 47907USA Purdue center for Plant Biology Purdue UniversityWest LafayetteIN 47907USA Department of Horticulture and Landscape Architecture Purdue UniversityWest LafayetteIN 47907USA

Lithospermum erythrorhizon(red gromwell;zicao)is a medicinal and economically valuable plant belonging to the Boraginaceae *** from *** have been used for centuries based on the antiviral and woundhealing properties produced from the bioactive compound shikonin and its *** recently,shikonin,its enantiomer alkannin,and several other shikonin/alkannin derivatives have collectively emerged as valuable natural colorants and as novel drug *** several transcriptomes and proteomes having been generated from ***,a reference genome is still *** has limited investigations into elucidating the shikonin/alkannin pathway and understanding its evolutionary and ecological *** this study,we obtained a de novo genome assembly for *** using a combination of Oxford Nanopore long-read and Illumina short-read sequencing *** resulting genome is∼367.41 mb long,with a contig N50 size of 314.31 kb and 27,720 predicted protein-coding *** the *** genome,we identified several additional phydroxybenzoate:geranyltransferase(PGT)homologs and provide insight into their evolutionary *** analysis of prenyltransferases suggests that PGTs originated in a common ancestor of modern shikonin/alkanninproducing Boraginaceous species,likely from a retrotransposition-derived duplication event of an ancestral prenyltransferase ***,knocking down expression of LePGT1 in *** hairy root lines revealed that LePGT1 is predominantly responsible for shikonin production early in culture *** together,the reference genome reported in this study and the provided analysis on the evolutionary origin of shikonin/alkannin biosynthesis will guide elucidation of the remainder of the pathway.

关键词： insight collective evolutionary

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环GmP抑制的环AmP磷酸二酯酶产生的内皮源性NO的基础释放促进前列环素引起的小猪肺动脉舒张(英文)

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Acta Pharmacologica Sinica 2000年第2期21卷 37-44页

作者： Thomas m ZELLERS,jennifer mccORmIcK,Paul m VANHOUTTE Department of Pediatrics Division of cardiology University of Texas Southwestern medical center at Dallas 5323 Harry Hines Boulevard Dallas TX 75235 Department of Pediatrics Division of cardiology University of Texas Southwestern medical center at Dallas 5323 Harry Hines Boulevard Dallas TX 75235 IRIS 6 Place de Pleiades 92415 courbevoie France

AIm: To study the interactions between prostacyclin and endothelium-derived nitric oxide in porcine pulmonary arteries. mETHODS: Rings of 5th order of porcine pulmonary arteries were studied in vitro for the measurement of tension and the content in cyclic nucleotides. RESULTS: Prostacyclin, given exogenously, caused en-dothelium-potentiated relaxations (inhibition of phenyle-phrine contraction) that were inhibited by the inhibitors of the L-arginine nitric oxide pathway, oxyhemoglobin and Nω-nitro-L-arginine. These inhibitors did not affect the tension in rings without endothelium. cyclic GmP-con-centrations were not increased above basal concentrations in the presence of prostacyclin. Increases were seen with acetylcholine and sodium nitroprusside. Prostacyclin-stimulated cyclic AmP concentrations did not reach statistical significance compared to controls. The addition of 8-bromo-cyclic GmP to prostacyclin, however, increased the cyclic AmP content. The nitric oxide synthase inhibitor, nitro-L-argin

关键词：肺动脉血管内皮硝酸依前列醇环鸟苷一磷酸环腺苷一磷酸磷酸二酯水解酶

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Including Extra Virgin Olive Oil may more Improve Glycemic control despite Similar Weight Loss compared to the Diet Recommended by the Prostate cancer Foundation: A Randomized, Pilot Study

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Journal of cancer Therapy 2017年第10期8卷 880-890页

作者： mary m. Flynn jennifer cunningham Joseph Renzulli Anthony mega Department of medicine The Miriam Hospital Providence RI USA

Recommendations for prostate cancer treatment include weight loss, but the most efficacious diet has not been determined. men on active surveillance or with untreated biochemical relapse consumed both the diet recommended by the Prostate cancer Foundation (PcF) and a plant-based that included three tablespoons of extra virgin olive oil per day for 8 weeks of weight loss and improvement in some laboratory biomarkers with random assignment to the diet order. They then selected one of the diets for six months of follow-up. Thirty men started the protocol and 18 completed the 44 week study. mean age: 66.6 ± 5.9 years;baseline body mass index: 30.9 ± 2.7 kg/m2. Weight loss was comparable between the diets after 8 weeks (PcF: 2.5% ± 3.1% v olive oil: 2.8% ± 3.7%;p = 0.86), but the diet that included olive oil resulted in lower insulin (PcF: 13.7 ± 7.0 mU/L v olive oil: 11.5 ± 4.4 mU/L;p = 0.02), glucose (PcF: 104.9 ± 9.9 mg/dl v 99.1 ± 9.6 mg/dl;p = 0.01), and HOmA-IR (PcF: 3.6 ± 2.1 v olive oil: 2.9 ± 1.2;p = 0.02). Thirteen of the 18 men choose the olive oil diet for six months of follow-up and weight loss and lab improvements were maintained. This pilot study indicates that both the PcF diet and the plant-based diet that included extra virgin olive oil can produce similar weight loss short-term. However, a plant-based diet that includes extra virgin olive may be more acceptable for long-term use, and produce better glycemic control.

关键词： Prostate cancer Extra Virgin Olive Oil Weight management

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Are midwestern fish retailers willing to pay more for regionally grown fresh-on-ice fish?

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Agricultural Sciences 2013年第6期4卷 39-45页

作者： Rejeana m. Gvillo Kwamena Quagrainie Nicole Olynk jennifer Dennis Department of Agricultural Economics Purdue University West Lafayette USA Department of Agricultural Economics Texas A&M University College Station USA

The fish and seafood market in the midwestern region of the United States is currently dominated by frozen products. Fish producers in the region may be able to market their products as fresh, regionally grown and farmed fish. Fish producers may be able to supply fresh fish products that have not been previously frozen but preserved fresh with ice. The study examined retailers’ willingness to pay more for midwestern fresh fish adopting the literature on consumers’ willingness to pay for market services or products, assuming that retailers understand their customers, and that they are able to add any premiums paid for to their retail prices. The overall probability of retailers paying more for regionally grown fresh-on-ice fish is low though consistency in supply and sourcing out of state positively affected the probability to pay more. In spite of these positive factors on willingness to pay more for midwestern fresh-on-ice fish, midwestern fish producers would probably remain non-competitive in the fresh-on-ice fish market in the short and medium term, and should continue to focus on the live market.

关键词： Fresh Fish midwest Willingness to Pay Ordered Probit

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Bacterial colonization of the Equine Gut;comparison of mare and Foal Pairs by PcR-DGGE

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Advances in microbiology 2012年第2期2卷 79-86页

作者： jennifer E. Earing Andrew c. Durig Gloria L. Gellin Laurie m. Lawrence michael D. Flythe Agricultural Research Service Forage-Animal Production Research Unit USDA Lexington USA Department of Animal and Food Sciences University of Kentucky Lexington USA Department of Animal and Food Sciences University of Kentucky Lexington USA Agricultural Research Service Forage-Animal Production Research Unit USDA Lexington USA

Horses, like all animals, are born without the symbiotic microbes that occupy the gastrointestinal tracts of mature animals. As grazing animals, horses rely on these microbes to fully utilize the grasses and other cellulosic feeds that they consume. Thus, colonization of the foal's gastrointestinal tract must occur between birth and weaning. The feces of nine mare and foal pairs were sampled from the day of parturition until 12 weeks of age, and the samples were analyzed by polymerase chain reaction amplification of the bacterial 16S rRNA gene and denaturing gradient gel electrophoresis (PcR-DGGE). The gels from feces of day (d) 0 foals had no or very few ( x = 3, n = 6) bands, which indicates that species richness was low. The number of bands increased during the first 4 days of life, and by d 14 the foals and mares had similar numbers of bands ( x = 28, n = 23). Some bands were present in young foals, but not in mares or in foals on d 42 or d 84, which indicated succession of bacterial species. When the PcR-DGGE profiles were compared with Dice's algorithm, all mare-foal pairwise similarities on d 14 and later were as great as the pairwise similarities between mares. These results are consistent with the idea that foals are born with a sterile gut, colonization proceeds rapidly, and a mature microbial community is present in the first few weeks of life.

关键词： colonization Development microbial Ecology Neonates

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Application of Drone in Solving Last mile Parcel Delivery

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Journal of Systems Science and Information 2018年第4期9卷 302-319页

作者： Jiashi LIU Zhongliang GUAN jennifer SHANG Xiang XIE School of Economics and management Beijing Jiaotong University Joseph m.Katz Graduate School of Business University of Pittsburgh

The article is about solving the last mile delivery problem in rural town or village. We want to test the drone’s potential in parcel delivery. The objectives are 1) to introduce the cluster and truck-drone in tandem delivery method, 2) to compare the new method with the traditional TSP method in aspect of truck running distance, energy using and time occupation. The parcel delivery demand is sparse, so it is not dense enough for a truck to carry on delivery. We try to identify the best route for the drone to deliver the goods. We use k-mean method to carry on clustering, then we use enumeration method to fulfill the centroids delivery, which comes from the depot. We design a model and calculate the energy, time and distance saving between drone using method(DTSP) and traditional TSP method. The drone attended delivery saves truck delivery distance, energy consumption and *** truck running distance of DTSP method saves 91.87%, the truck running distance is shortened from 189.69 km to 15.4252 km. The DTSP method saves 90.45% of energy. The DTSP method brings a29.75% cutoff in time aspect when there are two drone in running. The research introduces the cluster and TSP combination method, which is a good way to carry on last mile delivery. The result shows a bright future for drone to attend parcel delivery. The e-commerce corporation can apply this method in practice.

关键词： drone last mile delivery e-commerce genetic algorithm

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