多野照射、三维适形放疗与调强放疗对胃癌根治术患者癌周围组织的影响

目的:探讨多野照射、三维适形放疗与调强放疗对胃癌根治术患者癌周围组织的影响。方法:选取收治的103例行胃癌根治术的患者,将所有患者随机分为甲乙丙三组,其中甲组患者34例,均采用多野照射治疗;而乙组患者也是34例,均使用三维适形放疗;丙组患者则有35例,均使用调强放疗。观察比较各组患者放疗后的上腹部症状改善情况,并且检测各组患者的肝功能和血常规以及胰淀粉酶等临床指标,比较各组患者经治疗后的复发率以及生存率。结果:甲组患者的近期疗效显著低于乙组患者(P0.05),而乙组患者的近期疗效则明显低于丙组患者(P0.05);三组患者的钡餐造影均有所改善,但是其组间比较差异不具有统计学意义(÷2=9.012,P0.05)。甲组的不良反应率显著高于乙组和丙组(均P0.05),并且各组患者的不良反应中血常规异常的发生率显著高于肝功能和胰脏功能的异常(均P0.05),同时甲组患者出现放射性脊髓病的患者明显多于乙组(P0.05),仅丙组患者未见放射性脊髓病。随访三年间三组患者第一年随访生存率无明显差异(P0.05),而在第2年至第3年则三组患者的随访生存率有明显差异(均P0.05),其中随访生存率以丙组患者最高,其次为乙组患者;另外随访三年间甲组患者的随访复发率显著高于乙组和丙组患者(均P0.05),其复发率由低至高依次为丙组乙组甲组。结论:与多野照射治疗相比,三维适形放疗和调强放疗均能够更好地降低对胃癌周围组织的损伤和改善患者的临床症状,并且不良反应发生率低,对于降低复发率和提高生存率方面亦有不错的效果。     

髋臼粉碎性骨折治疗方法的选择与预后探讨

目的:研究髋臼粉碎性骨折采用骨牵引与手术治疗的疗效的比较。方法:将118例髋臼粉碎骨折患者分为骨牵引组(74例)和手术组(44例),分别进行比较。结果:骨牵引组解剖复位10例(13.5%)、满意复位26例(35.1%),自我感觉优8例(10.8%)、良24例(32.4%);手术组解剖复位9例(40.9%)、满意复位12例(54.5%),自我感觉优7例(31.8%))、良9例(40.9%)。结论:手术治疗髋臼粉碎性骨折疗效明显优于骨牵引。     

在线推定和控制葡萄糖浓度改善谷氨酸发酵性能

谷氨酸发酵过程一般需要定时、人工分批式地添加葡萄糖。该流加操作方式会引起发酵罐内葡萄糖浓度的剧烈波动, 不利于高效、稳定的谷氨酸生产。谷氨酸发酵具有显著的非增殖耦联特征, 产酸期葡萄糖耗量与氨水耗量存在非常明显的关联性。通过在线计量氨水耗量推定糖耗以及葡萄糖浓度, 可比较准确地将谷氨酸发酵产酸期的糖浓度控制在预先设定的水平。当糖浓度控制在5 g/L~10 g/L的低水平时, 最终谷氨酸浓度可以达到80 g/L的较高水平, 高糖浓度下的渗透压效应有望得到缓解, 有利于发酵生产的稳定。     

基于FMEA法的结肠癌根治术风险识别研究

目的 探讨结肠癌根治术的高危风险以及引起风险的主要原因,提出有效的干预策略。方法 应用失效模式与效应分析法对结肠癌根治术进行风险识别研究。 结果 分析得出结肠癌根治术共计8项流程,26项失效环节,排在前10位的高危风险分别为：观察患者药物反应失误、设备仪器准备不充分、检查时间过长、术前宣教不佳、麻醉前核对失误、手术时间过长、排药错误、术后注意事项告知有误、护士术后核对失误、手术者术后核对失误。结论 FMEA法可以有效地识别高危风险,据此有针对性地制定措施、采取策略,能够最终从源头上避免风险的发生。     

内支架对大肠癌急性梗阻一期切除吻合疗效的探讨

目的:探讨内支架对大肠癌急性梗阻一期切除吻合的疗效。方法:选择2010年7月至2012年7月来我院急诊治疗确诊为大肠癌导致急性肠梗阻的患者98例,随机分为观察组和对照组各49例,观察组患者植入内支架,一周后行一期吻合切除术,对照组行急诊切除手术。观察和比较两者患者一期切除率、治疗效果和并发症的情况。结果:观察组一期切除率为95.7%(47例)较对照组分71.4%(35例)高;两组比较差异均有统计学意义(x2=22.9,P0.05);实验组症状缓解48例(缓解率98%),对照组症状缓解33例(缓解率67.3%),两组临床疗效比较有显著性差异(x2=33.3,P0.001),实验组术后并发症发生率(10.2%)要明显小于对照组(26.5%)(x2=9.6,P0.01)。结论:大肠癌急性梗阻术前植入内支架能有效提高患者的一期手术吻合率和治疗效果,降低术后并发症,值得在临床推广。     

A型肉毒毒素联合眼袋整形术对眼周皮肤松弛患者的疗效观察

目的:探讨A型肉毒毒素联合眼袋整形术对眼周皮肤松弛患者的治疗效果和对患者满意度的影响,为临床提供参考。方法:选取2015年6月至2016年6月间因眼周皮肤松弛来我院治疗的患者60例。患者根据自身意愿选择治疗方式,按其选择的治疗方式分组为对照组(n=28)和治疗组(n=32)。对照组采用单纯眼袋整形术进行治疗,治疗组采用A型肉毒毒素联合眼袋整形术治疗。治疗后对两组患者均随访6个月。观察记录患者手术后鱼尾纹的改善效果、眼袋减轻的情况和眼周皮肤光泽的改善效果。观察患者并发症的发生情况。随访结束时采用自制的满意度调查问卷对患者满意度进行调查。结果:经过治疗,治疗组鱼尾纹改善率为100.00%,明显高于对照组的60.71%;治疗组眼袋改善率为96.88%,明显高于对照组的32.14%;治疗组皮肤光泽改善率为87.50%,明显高于对照组的53.57%,差异均具有统计学意义(均P0.05)。治疗后,两组患者切口红肿、少量分泌物、小血肿的发生率比较无明显差异(P0.05),治疗组术眼红肿与外眦部切口瘀痕发生率明显少于对照组(P0.05)。治疗组总满意率为93.75%(30/32),明显高于对照组的67.86%(19/28),差异具有统计学意义(P0.05)。结论:A型肉毒毒素与眼袋整形术联合应用在眼周皮肤松弛的治疗上有较好的疗效和安全性,能明显降低患者术眼红肿与外眦部切口瘀痕的发生,并提高患者满意率,值得在临床上推广应用。     

Limnology of a Warm Hypertrophic Wastewater Reservoir in Israel I. The Physical Environment

This paper deals with stratification in a small reservoir (50 000 m³ volume, 5.5 m depth) receiving wastewater with a BOD of 80 mg/1 during the winter in order to irrigate agricultural areas during the dry summer. The reservoir goes through three partially overlapping annual cycles: solar radiation, water temperature and reservoir operation. It presents both permanent (deep) and ephemeral (shallow) stratification during the summer in spite of the strong breeze, due to both thermal and biogenic chemical gradients. There are stratified and non-stratified wastewater reservoirs in Israel. Stratification in hypertrophic impoundments seems to depend also on parameters derived from the chemical composition of hypertrophic waters. (e. g., turbidity, biogenic gradients, wind/water friction coefficient, viscosity).     

节点控制在手术安全管理中的运用与实践

运用节点控制理念,对围手术期患者高危环节进行风险评估,确定从患者手术申请至术后回病房或重症监护室等8个影响手术质量与安全的关键节点,运用信息化和人工辅助相结合的方式,实施节点控制和流程管控,实现手术全程流程化、可控化安全监管和无缝对接,从而确保医疗核心制度的规范执行,降低围手术期差错发生率、提高手术运行效率,实现手术患者安全管理的目标。

     

From Lithium‐Oxygen to Lithium‐Air Batteries: Challenges and Opportunities

Lithium ‐ air batteries have become a focus of research on future battery technologies. Technical issues associated with lithium‐air batteries, however, are rather complex. Apart from the sluggish oxygen reaction kinetics which demand efficient oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) catalysts, issues are also inherited from the nature of an open battery system and the use of reactive metal lithium as anode. Lithium‐air batteries, which exchange oxygen directly with ambient air, face more challenges due to the additional oxidative agents of moisture, carbon dioxide, etc. which degrade the metal lithium anode, deteriorating the performance of the batteries. In order to improve the cycling performance one must hold a full picture of lithium‐oxygen electrochemistry in the presence of carbon dioxide and/or moisture and fully understand the fundamentals of chemistry reactions therein. Recent advances in the exploration of the effect of moisture and CO₂ contaminants on Li‐O₂ batteries are reviewed, and the mechanistic understanding of discharge/charge process in O₂ at controlled level of moisture and/or CO₂ are illustrated. Prospects for development opportunities of Li‐air batteries, insight into future research directions, and guidelines for the further development of rechargeable Li‐air batteries are also given.     

Process development of a New Haemophilus influenzae type b conjugate vaccine and the use of mathematical modeling to identify process optimization possibilities

Vaccination is one of the most successful public health interventions being a cost‐effective tool in preventing deaths among young children. The earliest vaccines were developed following empirical methods, creating vaccines by trial and error. New process development tools, for example mathematical modeling, as well as new regulatory initiatives requiring better understanding of both the product and the process are being applied to well‐characterized biopharmaceuticals (for example recombinant proteins). The vaccine industry is still running behind in comparison to these industries. A production process for a new Haemophilus influenzae type b (Hib) conjugate vaccine, including related quality control (QC) tests, was developed and transferred to a number of emerging vaccine manufacturers. This contributed to a sustainable global supply of affordable Hib conjugate vaccines, as illustrated by the market launch of the first Hib vaccine based on this technology in 2007 and concomitant price reduction of Hib vaccines. This paper describes the development approach followed for this Hib conjugate vaccine as well as the mathematical modeling tool applied recently in order to indicate options for further improvements of the initial Hib process. The strategy followed during the process development of this Hib conjugate vaccine was a targeted and integrated approach based on prior knowledge and experience with similar products using multi‐disciplinary expertise. Mathematical modeling was used to develop a predictive model for the initial Hib process (the ‘baseline’ model) as well as an ‘optimized’ model, by proposing a number of process changes which could lead to further reduction in price. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:568–580, 2016