腹腔镜手术治疗粘连性肠梗阻的疗效及安全性研究

目的：探讨腹腔镜粘连松解术治疗粘连性肠梗阻（AIO）的疗效，减少再梗阻率。方法：将120 例AIO 患者随机分为两组，每 组60 例，开腹组实施开腹手术，腹腔镜组实施腹腔镜粘连松解术，观察两组术后恢复及并发症发生情况，对再梗阻危险因素进行 Logistic 回归分析。结果：腹腔镜组术中失血量（73.48± 9.32）mL，少于开腹组的（207.45± 33.21）mL（P<0.05）；腹腔镜组手术、术后 镇痛、下床活动、肠恢复蠕动、肛门恢复排气、拔除尿管及住院时间分别为（69.15± 10.13）min、（14.67± 7.23）h、（27.14± 7.04）h、 （3.11± 0.96）d、（3.24± 1.02）d、（3.37± 1.23）d、（7.95± 3.05）d，均短于开腹组的（83.84± 9.24）min、（27.38± 8.02）h、（36.23± 5.87） h、（4.05± 1.35）d、（4.35± 1.74）d、（5.02± 2.13）d、（10.35± 3.71）d（P<0.05)；腹腔镜组并发症发生率、再梗阻率分别为10.00%、 10.00%，均低于开腹组的33.33%、40.00%（P<0.05)；多因素Logistic 回归分析显示开腹手术、手术时间≥ 60 min 是再梗阻发生的独 立危险因素。结论：腹腔镜手术治疗AIO 疗效优于开腹手术，而且并发症与再梗阻率低。     

Testing parameter sensitivities and uncertainty analysis of Biome-BGC model in simulating carbon and water fluxes in broadleaved-Korean pine forests

生态过程模型的发展为研究者在长时间序列和区域尺度的研究提供了便利, 但模型模拟的准确性受到模型自身结构、模型参数估计合理性的影响。敏感性分析能够定量或定性筛选出对模型模拟结果影响较大的敏感参数, 是模型参数校准过程中的重要工具, 也是建模和应用的先决条件。该文以阔叶红松林为研究对象, 采用全局敏感性分析方法——傅里叶幅度灵敏度检验扩展法(EFAST)对Biome-BGC模型的生理生态参数进行了敏感性分析, 分别分析了红松(Pinus koraiensis)和阔叶树的净初级生产力(NPP)、蒸散(ET)对参数变化的敏感性。结果表明: (1)模拟红松NPP的不确定性高于阔叶树, 但二者的模拟ET的不确定性均较小。阔叶树的NPP和ET对生理生态参数的敏感性总体上都小于红松。(2)无论是红松、阔叶或其他植被类型, 模拟NPP均表现出对叶片碳氮比、细根碳氮比、比叶面积(SLA)和冠层截留系数的敏感性, 这4个参数的高敏感性主要是由模型自身结构所决定的, 与植被类型和研究地区的关系较小。对模拟ET而言, 细根与叶片碳分配比、新茎与新叶碳分配比和SLA均是影响红松和阔叶树ET的敏感参数, 但红松ET主要受参数与参数间的二阶或多阶交互作用的间接影响, 而阔叶树ET则主要是受到敏感参数直接效应的影响。(3)除了上述影响红松和阔叶树碳水通量的共性参数外, 诸如核酮糖-1,5-二磷酸羧化酶中叶氮含量、叶片与细根周转率、所有叶面积与投影叶面积之比等也是对模拟结果有影响的重要参数, 但是其敏感程度随物种不同和研究区不同而不同, 所以这类参数可以根据具体情况进行参数本地化, 对于其他不敏感参数则可以采用模型缺省值。     

Mechanical performance of endodontic restorations with prefabricated posts: sensitivity analysis of parameters with a 3D finite element model

Many studies have investigated the effect of different parameters of the endodontically restored tooth on its final strength, using in vitro tests and model simulations. However, the differences in the experimental set-up or modelling conditions and the limited number of parameters studied in each case prevent us from obtaining clear conclusions about the relative importance of each parameter. In this study, a validated 3D biomechanical model of the restored tooth was used for an exhaustive sensitivity analysis. The individual influence of 20 different parameters on the mechanical performance of an endodontic restoration with prefabricated posts was studied. The results bring up the remarkable importance of the loading angle on the final restoration strength. Flexural loads are more critical than compressive or tensile loads. Young's modulus of the post and its length and diameter are the most influential parameters for strength, whereas other parameters such as ferrule geometry or core and crown characteristics are less significant.     

Effect of soil water stress on soil respiration and its temperature sensitivity in an 18-year-old temperate Douglas-fir stand

We analyzed 17 months (August 2005 to December 2006) of continuous measurements of soil CO₂ efflux or soil respiration (R_S) in an 18‐year‐old west‐coast temperate Douglas‐fir stand that experienced somewhat greater than normal summertime water deficit. For soil water content at the 4 cm depth (θ) > 0.11 m³ m^?3 (corresponding to a soil water matric potential of ?2 MPa), R_S was positively correlated to soil temperature at the 2 cm depth (T_S). Below this value of θ, however, R_S was largely decoupled from T_S, and evapotranspiration, ecosystem respiration and gross primary productivity (GPP) began to decrease, dropping to about half of their maximum values when θ reached 0.07 m³ m^?3. Soil water deficit substantially reduced R_S sensitivity to temperature resulting in a Q₁₀ significantly < 2. The absolute temperature sensitivity of R_S (i.e. dR_S/dT_S) increased with θ up to 0.15 m³ m^?3, above which it slowly declined. The value of dR_S/dT_S was nearly 0 for θ < 0.08 m³ m^?3, thereby confirming that R_S was largely unaffected by temperature under soil water stress conditions. Despite the possible effects of seasonality of photosynthesis, root activity and litterfall on R_S, the observed decrease in its temperature sensitivity at low θ was consistent with the reduction in substrate availability due to a decrease in (a) microbial mobility, and diffusion of substrates and extracellular enzymes, and (b) the fraction of substrate that can react at high T_S, which is associated with low θ. We found that an exponential (van't Hoff type) model with Q₁₀ and R₁₀ dependent on only θ explained 92% of the variance in half‐hourly values of R_S, including the period with soil water stress conditions. We hypothesize that relating Q₁₀ and R₁₀ to θ not only accounted for the effects of T_S on R_S and its temperature sensitivity but also accounted for the seasonality of biotic (photosynthesis, root activity, and litterfall) and abiotic (soil moisture and temperature) controls and their interactions.     

The position of the epistatic S locus in the halothane linkage group in pigs

The linkage of the Phi, Pgd, Po2, S, H and halothane sensitivity loci was followed in a Belgian Landrace family, heterozygous for these systems over 6 generations. Recombination next to the S locus occurred mainly in pigs belonging to this particular family. From this investigation the position of the S locus is proved to be outwith the Phi-Pgd region, next to Phi . Therefore the gene sequence S - Phi - Hal -H- Po2 -Pgd is proposed. Higher recombination rates were observed in the female parental line of the multiheterozygous family when compared to the male parental line. Additional data from animals, unrelated to this strain, confirm the evidence of close linkage of the S system to the nearest marker loci.     

Diagnostic accuracy of fine-needle aspiration cytology in histological grade 1 breast carcinomas: are we good enough?

Background: Fine-needle aspiration cytology (FNAC) of both palpable and non-palpable breast carcinomas has a high accuracy and sensitivity in dedicated centres. It is generally thought that low-grade carcinomas have a distinctly lower sensitivity due to discrete cellular atypia that may be difficult to appreciate. Grade 1 carcinomas make up about 45% of screening-detected breast carcinomas and about 20% of symptomatic breast cancers. The aim of this study was to evaluate the diagnostic sensitivity of grade 1 carcinomas and identify the critical features in the cytological diagnostic work-up of these tumours. Methods: There were FNAC smears from 494 histologically confirmed grade 1 carcinomas diagnosed during 1996–2004. The cytological diagnoses were compared with the histology. Results: A definitive malignant diagnosis (absolute sensitivity) was given in 382 cases (77.3%). Equivocal or suspicious diagnoses were given in 75 (15.2%), benign or probably benign (false negative) in 24 (4.8%). Thirteen cases (2.6%) were unsatisfactory. Complete sensitivity was 92.7%. Invasive ductal carcinomas comprised 81.3% of all cases; absolute sensitivity for these was 80.9%. Invasive lobular and tubular carcinomas comprised 7.3% and 5.9% of cases, respectively; absolute sensitivity for these diagnosis was 50.0% and 57.1%, respectively, significantly lower than for other subtypes (P ≤ 0.0001) whereas the difference for complete sensitivity was less but still significant (P = 0.017). Absolute and complete sensitivities were lower for tumours less than 1 cm size compared with more than 1 cm (P ≤ 0.00001). Conclusion: Preoperative FNAC diagnosis of grade 1 breast carcinoma has a high sensitivity, especially in ductal carcinomas. Invasive lobular and tubular carcinomas were less likely to receive a definite preoperative diagnosis. The main reason for not reaching a definitive malignant diagnosis was sampling error due to small tumours less than 1 cm in diameter, irrespective of tumour subtype.     

SOUND PRODUCTION IN THE LARVAE OF GEOTRUPES SPINIGER (MARSHAM) (COLEOPTERA: GEOTRUPIDAE)

ABSTRACT

This paper focuses on sound production in the larvae of Geotrupes spiniger (Marsham) (Coleoptera: Geotrupidae). A single stridulatory apparatus was identified and then analysed from a structural point of view. Sound was studied using spectography and results included a quantitative analysis with characterizing physical parameters. Results highlight the need to study stridulation in Geotrupidae more in detail, to improve our understanding of its evolutionary and biological meaning.     

基于“心与小肠相表里”理论探讨肠道微生态与骨质疏松症的关系

近年来相关研究显示,肠道微生态在骨质疏松症的发生发展中起着重要作用。中医脏腑理论密切关注脏腑之间的生理病理关系,以中医经典《内经》“心与小肠相表里”理论为基础,探讨心、小肠、肠道微生态与骨质疏松症之间的关系。研究发现肠道微生态可能是心系疾病导致骨质疏松症的途径之一,这一发现可能为骨质疏松症的研究与防治提供一定的理论依据。     

Íleo biliar como causa de dolor abdominal en el paciente anciano

Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment.