腹腔镜手术治疗结肠癌的临床应用

目的:探讨腹腔镜手术治疗结肠癌的临床效果.方法:选取我院结肠癌患者44例,随机分为观察组和对照组,各22例,观察组行腹腔镜手术,对照组行开腹手术,比较两组的治疗效果和安全性.结果:两组患者的手术时间差异无统计学意义(P＞0.05),观察组的术中出血量明显少于对照组,差异有统计学意义(P＜o.05),观察组术后排气时间、术后疼痛时间和住院时间均比对照组更短,差异有统计学意义(P＜0.05).观察组和对照组并发症发生率分别为9.09％和22.73％,差异有统计学意义(P＜0.05).两组患者3年内局部复发、远处转移、种植转移和总生存率差异均无统计学意义(P＜0.05).结论:腹腔镜手术治疗结肠癌有效、安全,具有创伤小,恢复快,并发症少等优点,适合临床广泛应用.     

2D quantum mechanical device modeling and simulation: Centre-channel (CC) and double-gate (DG) MOSFET

In this paper, a novel device structure (Si_1 ? x Ge _x /Si/Si_1 ? x Ge _x hetero-structure), which is named as “center-channel (CC) double-gate (DG) MOSFET,” is proposed. Device performance of the proposed FET structure was investigated with our two-dimensional quantum-mechanical simulator which produces a self-consistent solution of Poisson–Schrödinger equations and the current continuity equation. The CC operation of CC-NMOS is confirmed from the electron density distribution and the band lineups as well as the lowest energy wave function. Current–voltage characteristics including the trans-conductance (G _m) of CC-MOSFET are carefully compared with those of the conventional DG-NMOS to evaluate the distinct feature of the proposed FET structure. Our simulation revealed that the proposed FET demonstrates the enhanced (about (～1.6 × ) current drive and 60% G _m. Finally, the short-channel effects of CC and DG MOSFET, both of which demonstrate excellent sub-threshold behaviors and open the possibility of device scaling down to sub-20 nm.     

Ross operation in a neuro-cardio-facial-cutaneous syndrome patient

Congenital heart diseases are a major part of Costello and cardio-facio-cutaneous syndromes. Subaortic stenosis was reported rarely and Ross operation never in these syndromes.We reported a girl patient whose manifestations were consistent with these syndromes. Distinction between these syndromes was not possible as genetic testing was not carried out. She developed severe neoaortic regurgitation 2.5 years after the Ross operation and died due to the complications of aortic valve replacement.Ross operation may be an unsuitable option in these syndromes due to the possibility of subtle pulmonic valve pathology.     

调强放疗联合替莫唑胺对高级别脑胶质瘤术后患者免疫功能和生活质量的影响

摘要 目的：观察调强放疗联合替莫唑胺对高级别脑胶质瘤术后患者免疫功能和生活质量的影响。方法：选择我院2015年7月~2017年9月收治的有完整临床资料的高级别脑胶质瘤患者107例,根据双色球随机分组法将患者分为对照组和观察组,分别为53例和54例,对照组给予调强放疗,观察组给予调强放疗联合替莫唑胺治疗,均治疗6周。对比两组疗效、免疫功能、生活质量、无进展生存时间、总生存时间和不良反应发生情况。结果：治疗6周后,观察组的客观缓解率55.56%、疾病控制率77.78%高于对照组的35.85%、56.60%（P<0.05）。观察组的无进展生存时间、总生存时间长于对照组（P<0.05）。治疗6周后,观察组的CD8⁺水平低于对照组,CD3⁺、CD4⁺水平高于对照组（P<0.05）。治疗6周后,观察组的躯体功能、机体疼痛、健康状况、生命力、心理职能、躯体角色、情感角色、社会功能维度评分高于对照组（P<0.05）。两组不良反应总发生率对比无显著性差异（P>0.05）。结论：调强放疗联合替莫唑胺应用于高级别脑胶质瘤术后患者,可减轻调强放疗导致的免疫抑制,提高患者生活质量,延长其无进展生存时间、总生存时间。     

Investigating the role of mechanics in lignocellulosic biomass degradation during hydrolysis: Part II

Lignocellulose breakdown in biorefineries is facilitated by enzymes and physical forces. Enzymes degrade and solubilize accessible lignocellulosic polymers, primarily on fiber surfaces, and make fibers physically weaker. Meanwhile physical forces acting during mechanical agitation induce tearing and cause rupture and attrition of the fibers, leading to liquefaction, that is, a less viscous hydrolysate that can be further processed in industrial settings. This study aims at understanding how mechanical agitation during enzymatic saccharification can be used to promote fiber attrition. The effects of reaction conditions, such as substrate and enzyme concentration on fiber attrition rate and hydrolysis yield were investigated. To gain insight into the fiber attrition mechanism, enzymatic hydrolysis was compared to hydrolysis by use of hydrochloric acid. Results show that fiber attrition depends on several factors concerning reactor design and operation including drum diameter, rotational speed, mixing schedule, and concentrations of fibers and enzymes. Surprisingly, different fiber attrition patterns during enzymatic and acid hydrolysis were found for similar mixing schedules. Specifically, for tumbling mixing, slow continuous mixing appears to function better than faster, intermittent mixing even for the same total number of drum revolutions. The findings indicate that reactor design and operation as well as hydrolysis conditions are key to process optimization and that detailed insights are needed to obtain fast liquefaction without sacrificing saccharification yields.     

损伤控制性手术在野战条件下腹部严重创伤治疗中的应用价值

目的:损伤控制性手术(Damage Control Operation,DCO)是针对严重创伤患者进行阶段性修复的外科策略,本文通过观察DCO在野战条件下严重腹部创伤治疗中的效果,探讨其应用价值,为野战外科手术提供参考。方法:对2012年2月-2013年3月我院收治的90例重症肝胆外伤患者的临床资料进行回顾性分析。将所选病例随机分为对照组和DCO组,每组45例。其中对照组实施常规手术治疗,DCO组实施损伤控制性手术进行治疗。对比两组患者的手术时间,术中出血量、死亡率、术后感染及并发症等。结果:DOC组手术时间为(62.59±8.61)min,术中出血量为(306.48±23.54)mL,死亡率为20%,术后感染率为8.89%,并发症的发生率为11.11%;对照组术时间为(90.35±7.86)min,术中出血量为(600.32±34.21)mL,死亡率为53.33%,术后感染率为24.44%,并发症的发生率为35.56%;DCO组患者的各项指标均优于对照组,差异显著且具有统计学意义(P0.05)。结论:在肝胆外科治疗中采用损伤控制性手术具有明显的临床效果,不但缩短了手术时间,减少出血量,提高手术成功率,而且降低了术后并发症的发生率,值得推广。     

急诊手术的职业暴露及防护对策

目的:通过对医务人员在急诊手术中职业暴露的情况调查,了解急诊手术中标准预防现状,提出合理化建议和措施。方法:对2007年6月-2010年5月手术患者乙肝、丙肝、梅毒、艾滋病的阳性率进行比较,现场调查急诊手术中防护用品的使用情况。结果:手术患者乙肝、丙肝、梅毒、艾滋病的阳性率逐年上升,职业暴露的危险性越来越大;急诊手术中医务人员防护用品使用率的高低取决于血液、体液、分泌物的污染程度。结论:对医务人员要加强职业安全教育,强化标准预防,提高医务人员的整体防护水平,避免或减少职业暴露的危害,在救死扶伤的同时,保护好自身安全。     

Demonstration of the use of windows of operation to visualize the effects of fouling on the performance of a chromatographic step

The high resolution afforded by packed bed chromatography makes it an indispensable operation in the downstream processing of therapeutic molecules. Packed bed performance is however inherently susceptible to changes in feed stream characteristics and fouling processes. The impact of fouling is seldom considered during the early stages of bioprocess development which is concerned with the selection of purification conditions. Instead these are performed with rigorously clarified feeds. Under such conditions, chromatography is effectively treated as an isolated step, independent from its preceding unit operations. In this study, we demonstrate how windows of operation could be used to visualize the impact of changes in the preceding clarification step on the fouling response of a subsequent cation exchange capture step. Laboratory columns (2,5 and 12 cm height) were subjected to varying fouling challenges of Escherichia coli lysate containing different amounts of solids carried over from the previous step. Changes in trans‐column pressure drop and breakthrough of the target protein (Fab′) were monitored. The limits of operability of the resin were determined with respect to the process material's properties. This information was used to extract the parameters for the adsorption kinetics used in the general rate (GR) model to create windows of operation for manufacturing scale operation. © 2011 American Institute of Chemical Engineers Biotechnol. Prog., 2011     

有上腹部手术史的腹腔镜胆囊切除术探讨

目的:探讨有上腹部手术史的腹腔镜胆囊切除术(LC)的临床经验。方法:对87例有上腹部手术史的腹腔镜胆囊切除术的临床资料进行回顾性分析。结果:84例顺利完成腹腔镜手术,3例中转开腹手术,其中因气腹建立困难1例,胆囊三角区解剖不清2例,所有病人恢复顺利,行LC术后2～4d出院,中转开腹5～7d出院。结论:只要术前充分准备和评估,灵活选择穿刺孔,有效的腹腔粘连松解,术者具备高超的腔镜操作技术和丰富的胆道手术经验,有上腹部手术史的LC术是安全,可行的。     

重大手术术前律师见证的作用探讨

目的:探讨对于重大手术进行术前律师见证的积极作用。方法:对我院自2004年10月至2011年12月1478例非急症手术的术前签字所进行的律师见证进行回顾分析。结果:患者家属及医务人员对这种手术签字形式予以肯定,无一例因告知不足引发的医疗纠纷发生。结论:手术律师见证是手术风险的合理分担,有利于保护医患双方的合法权益,减少医疗纠纷的发生,促进医学发展。