基于FMEA和POSSUM评分的手术风险评估研究

??????? 目的 研究建立手术风险评估的架构,以正确决策手术时机。方法 采用用于计数死亡率和并发症发生率的生理学和手术严重性（POSSUM）评分原理进行分层计分,同时引用失效模式与效应分析方法对手术可能发生故障模式的严重度及发生可能性及风险因素的影响度3个维度进行评估。结果 建立了手术前风险预警机制及手术评估架构,利用评估架构对某综合医院2010年200例80岁高龄的手术病人进行了术前评估,结果手术后并发症的发生率较2009年同年龄的手术病人的并发症下降了10.45%。结论 在手术前对手术相关因素进行评估,可以为手术时机的选择提供参考。     

基于FMEA的C形臂X线机的使用风险分析与控制

??????? 目的 基于失效模式与效应分析（FMEA）方法分析控制C形臂X线机的使用风险。方法 成立FMEA 5人小组,运用现场观察和访谈的方法,识别C形臂X线机使用的潜在失效模式,并对其发生的严重度、发生概率及检测的难易度进行评价打分,计算失效原因的风险优先指数。结果 FMEA小组找出了必须优先解决的C臂机使用的失效模式,制定并实施了改进措施,在不增加管理成本的基础上,取得了良好的管理效果。结论 FMEA可以评估医疗设备使用过程的失效,并能排序优先解决的问题,不增加管理成本就能预防问题的发生,是有效的过程管理工具。     

淹水-控温模式下砷污染水稻土溶液中砷形态的变化

以水稻种植区的砷污染土壤为研究对象,采用高效液相色谱(HPLC)-电感耦合等离子体质谱(ICP-MS)联用分析测试系统,研究了不同培养温度(5、27和50 ℃)对灭菌和不灭菌的土壤淹水后其溶液中砷赋存形态变化的影响.结果表明： 在土壤溶液中检测到的砷形态只有无机三价砷(As^Ⅲ)、无机五价砷(As^V)和有机的二甲基砷(DMA^V),未检测到单甲基砷(MMA^V)的存在;在不同控温条件下随淹水时间的延长,As^Ⅲ逐渐转变为砷的主要赋存形态,平均比例约为64%;As^V次之,约占35%,DMA^V的含量相对最低,约占1%;土壤灭菌与否对土壤溶液中五价砷的水平没有明显影响,但明显影响了五价砷的还原和促进了无机三价砷的甲基化,并且灭菌的促进效果随着淹水及培养时间的延长而逐渐降低;50 ℃、淹水23 d时,灭菌土壤溶液中DMA^V浓度最高,为23.7 ng·mL^-1,这说明灭菌土壤中残留的某些嗜热微生物成为优势菌群并促进了土壤溶液中砷的甲基化.结合水稻生长的实际环境条件对该研究结果进行分析,培养温度27 ℃淹水23 d后不灭菌的自然土壤溶液中砷浓度处于较低水平,因此在砷污染的水稻种植区建议采用短周期干湿交替的水分管理模式,在保障产量的情况下可尽量降低土壤溶液中砷的水平.     

稻草还田方式对双季水稻产量和土壤碳库管理指数的影响

采用田间定位试验,设置不施肥(CK)、单施化肥(NPK)、稻草切碎全量还田+化肥(SNPK)和稻草全部烧灰还田+化肥(SINPK)4个处理,研究不同稻草还田方式对双季稻产量和土壤碳素形态、碳库管理指数的影响.结果表明:2010—2011年两年四季的水稻平均产量SNPK与SINPK处理基本持平,但均显著高于NPK处理,增幅为5.7%～7.3%.与NPK和SINPK相比,SNPK能显著提高早稻产量,增幅在3.8%～8.8%.与单施化肥和稻草烧灰还田相比,SNPK提高了土壤不同形态碳素含量和碳库管理指数,总有机碳、活性碳、矿化碳和碳库管理指数分别提高了1.8%～2.0%、5.9%～6.5%、16.0%～41.6%和7.3%～7.8%.土壤碳库管理指数与早、晚稻产量呈显著抛物线关系,相关系数分别为0.999和0.980.SNPK能显著提高翌年早稻产量及土壤不同形态碳素含量和碳库管理指数.     

Process model comparison and transferability across bioreactor scales and modes of operation for a mammalian cell bioprocess

A Monod kinetic model, logistic equation model, and statistical regression model were developed for a Chinese hamster ovary cell bioprocess operated under three different modes of operation (batch, bolus fed‐batch, and continuous fed‐batch) and grown on two different bioreactor scales (3 L bench‐top and 15 L pilot‐scale). The Monod kinetic model was developed for all modes of operation under study and predicted cell density, glucose glutamine, lactate, and ammonia concentrations well for the bioprocess. However, it was computationally demanding due to the large number of parameters necessary to produce a good model fit. The transferability of the Monod kinetic model structure and parameter set across bioreactor scales and modes of operation was investigated and a parameter sensitivity analysis performed. The experimentally determined parameters had the greatest influence on model performance. They changed with scale and mode of operation, but were easily calculated. The remaining parameters, which were fitted using a differential evolutionary algorithm, were not as crucial. Logistic equation and statistical regression models were investigated as alternatives to the Monod kinetic model. They were less computationally intensive to develop due to the absence of a large parameter set. However, modeling of the nutrient and metabolite concentrations proved to be troublesome due to the logistic equation model structure and the inability of both models to incorporate a feed. The complexity, computational load, and effort required for model development has to be balanced with the necessary level of model sophistication when choosing which model type to develop for a particular application. © 2012 American Institute of Chemical Engineers Biotechnol. Prog., 2013     

不同分娩方式对产妇产后心理和生理的影响

目的:探讨不同分娩方式对产妇产后心理和生理的影响.方法:随机选择2011年1月～2011年12月在苏大附一院分娩的初产妇400例,其中剖宫产、阴道自然分娩各200例,对两组产妇产后42天心理状况、恶露持续时间、泌乳情况进行调查.结果:两种分娩方式对产妇产后42天发生焦虑和抑郁心理的影响无明显差别(P＞0.05);阴道自然分娩组产后恶露持续时间短于剖宫产组,差异有显著意义(P＜0.01).有抑郁、焦虑情绪的产妇泌乳始动时间显著长于正常产妇,24h泌乳量显著少于正常产妇(P＜0.01).结论:剖宫产对产妇身体生理创伤大过阴道自然分娩,应严格控制剖宫产的适应症,鼓励阴道自然分娩.     

Effect of genotype and graft type on the hydraulic characteristics and water relations of grafted melon

Abstract

From the measurements of the profiles of hydraulic conductance and water potential from soil through to the leaf system in fully established melon plants, the limits to water flow set by coupling of hydraulic conductance (k) with water relation parameters was evaluated in the laboratory using high pressure flow device (HPFM) and evaporative flux method (EF). The rootstock Arava was grafted onto self, and onto two genotypes (AR57 and AR82) using side and V graft types, and there was an ungrafted control. Hydraulic transport efficiency was estimated from measurements of evaporative flux (transpiration rate) and leaf water potential (ψL) measured between pre-dawn and sunset during the growth cycle. Measured parameters to characterize the hydraulic efficiency (architecture) of the vascular system of melon were normalized to areas of leaves and stem cross section; this enabled the examination of their physiological and ecological functions. The effects of rootstock genotype were more marked on graft union and scion water relations. Differences in the magnitudes of water relation parameters of hydraulic conductance, water potential (lwp) and evaporative water loss (EF) were detected. AR/RS82 side grafted exhibited high EF and Kh despite its lower leaf water potential compared to AR/RS57 V grafted. Self grafting (Arava/Arava grafts) in melon seems to improve water relations and xylem water transport efficiency. Parameters describing the hydraulic efficiency (architecture) of vascular system of melon plants were described in relation to plant attributes. The expression of hydraulic conductance of the root and shoot system relative to plant attributes did not eliminate differences in the magnitudes of conductance elements in tomato and melon. Differences obtained among the different melon grafts in whole plant leaf and stem area specific hydraulic conductance (Kl) indicate the carbon efficiency and hence the cost of resource allocation to areas of root surface and leaves. The role of plant water relations in root-shoot communications and whole plant regulation of water flux are inferred from this study.     

不同植皮方式修复大面积烧伤创面的临床效果分析

目的:比较邮票植皮、meek植皮以及自体微粒皮移植用于大面积烧伤患者创面修复的临床效果和可行性。方法:回顾性分析我院烧伤科收治的120例大面积烧伤患者的临床资料,根据不同的手术植皮方法分为微粒皮植皮组、Meek植皮组和邮票皮组,每组40例。三组患者入院后均给予常规基础治疗,再根据选择植皮方式的不同实施微粒皮植皮、Meek植皮和邮票皮植皮。对比三组患者的植皮成活率、创面一期愈合率、愈合时间、死亡率、1%烧伤面积(1%TBSA)治疗费用(元)以及康复效果(康复优良率)。结果:邮票皮组植皮成活率明显高于Meek植皮组(P0.05),Meek植皮组植皮成活率明显高于微粒皮植皮组(P0.05)。Meek植皮组和邮票皮组创面愈合时间均明显短于微粒皮植皮组(P0.05)。邮票皮组1%TBSA治疗费用明显低于Meek植皮组(P0.05),Meek植皮组1%TBSA治疗费用明显低于微粒皮植皮组(P0.05)。Meek植皮组和邮票皮组的创面一期愈合率均明显高于微粒皮植皮组(P0.05);Meek植皮组和邮票皮组的死亡率均明显低于微粒皮植皮组(P0.05);meek植皮组的瘢痕最轻,关节功能恢复最好;微粒皮植皮组瘢痕最重,关节功能恢复最差。结论:不同植皮方式用于大面积烧伤创面修复的临床效果各不相同。邮票皮成活率高、抗感染能力强,但扩张比例低,创面愈合效果差;meek皮扩张比例高、康复效果好,但抗感染能力差;微粒皮扩张比例最高,但成活率低,治疗成本高。临床上,应该根据患者的自身情况选择不同的植皮方式。     

关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。     

Species Determination and Quantitation in Mixtures Using MRM Mass Spectrometry of Peptides Applied to Meat Authentication

We describe a simple protocol for identifying and quantifying the two components in binary mixtures of species possessing one or more similar proteins. Central to the method is the identification of ''corresponding proteins'' in the species of interest, in other words proteins that are nominally the same but possess species-specific sequence differences. When subject to proteolysis, corresponding proteins will give rise to some peptides which are likewise similar but with species-specific variants. These are ''corresponding peptides''. Species-specific peptides can be used as markers for species determination, while pairs of corresponding peptides permit relative quantitation of two species in a mixture. The peptides are detected using multiple reaction monitoring (MRM) mass spectrometry, a highly specific technique that enables peptide-based species determination even in complex systems. In addition, the ratio of MRM peak areas deriving from corresponding peptides supports relative quantitation. Since corresponding proteins and peptides will, in the main, behave similarly in both processing and in experimental extraction and sample preparation, the relative quantitation should remain comparatively robust. In addition, this approach does not need the standards and calibrations required by absolute quantitation methods. The protocol is described in the context of red meats, which have convenient corresponding proteins in the form of their respective myoglobins. This application is relevant to food fraud detection: the method can detect 1% weight for weight of horse meat in beef. The corresponding protein, corresponding peptide (CPCP) relative quantitation using MRM peak area ratios gives good estimates of the weight for weight composition of a horse plus beef mixture.