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。     

急性高容量血液稀释联合控制性低中心静脉压对脊柱后路手术患者炎症免疫调节及血液保护作用研究

摘要 目的：探讨急性高容量血液稀释（AHH）联合控制性低中心静脉压（CLCVP）对脊柱后路手术患者炎症、免疫调节、血液保护的作用。方法：选择2020年1月至2022年12月于南京鼓楼医院行脊柱后路手术的120例患者作为研究对象,根据随机数字表法分为对照组、AHH组、AHH+CLCVP组,每组各40例。对照组给予乳酸钠林格氏液血液稀释,AHH组给予AHH血液管理,AHH+ CLCVP组给予AHH联合CLCVP血液管理。比较三组围术期指标、血流动力学指标、炎症因子指标、免疫功能指标的变化情况。结果： AHH+CLCVP组术中出血量、悬浮红细胞输注量低于AHH组和对照组（P＜0.05）,AHH组术中出血量、悬浮红细胞输注量低于对照组（P＜0.05）。与T1时间点相比,三组心率（HR）于手术开始后60 min（T2）~术毕（T3）先升高后降低（P＜0.05）,平均动脉压（MAP）先降低后升高（P＜0.05）,对照组和AHH组中心静脉压（CVP）于T2~T3先升高后降低（P＜0.05）,AHH+CLCVP组T0~T3 CVP保持稳定水平（P＞0.05）。AHH+CLCVP组T2~T3 HR低于AHH组和对照组（P＜0.05）,MAP高于AHH组和对照组（P＜0.05）,CVP低于AHH组和对照组（P＜0.05）,AHH组T2~T3 HR低于对照组（P＜0.05）,MAP高于对照组（P＜0.05）。与T1时间相比,三组血清降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）水平、外周血CD8⁺于T2~术后24 h（T4）先升高后降低（P＜0.05）,外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺于T2~T4先降低后升高（P＜0.05）。AHH+CLCVP组T2~T4血清PCT、CRP、IL-6水平、外周血CD8⁺低于AHH组和对照组（P＜0.05）,外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺高于AHH组和对照组（P＜0.05）,AHH组T2~T4血清PCT、CRP、IL-6水平、外周血CD8⁺低于对照组（P＜0.05）,外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组（P＜0.05）。结论：AHH联合CLCVP可稳定脊柱后路手术患者血流动力学,减少术中出血量和输血量,降低炎症反应,提高免疫功能。     

损伤控制性手术在肝胆外科治疗中的临床应用价值

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在肝胆外科治疗中的效果,探讨其临床应用价值,为肝胆外科手术治疗提供参考。方法:选取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:DCO组手术时间为(62.59±8.61)min,术中出血量为(306.48±23.54)m L,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)m L,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,降低死亡率,提高手术成功率,而且降低了术后并发症及感染的发生率,值得推广。     

Investigation of the Potential and Mechanism of Clove for Mitigating Airborne Particulate Matter Emission from Stationary Sources

Vegetative Barriers (VB) have the potential to mitigate air pollutants emitted from area sources,including concentrated Animal Feeding Operations (AFOs).However,the mechanism has not been fully investigated,thereby limiting the application of vegetation systems in practice.An experimental method with repeatable and controllable conditions was developed to measure the change of Particulate Matter (PM) concentrations at upwind and downwind of VB in the wind tunnel and observe accumulated PM on leaves with Scanning Electron Microscope (SEM),thus evaluating the ability of VB in mitigating PM emitted from AFOs.Branch-scale vegetation,clove (syzygium aromaticum) was selected because its leaves are one of the major factors affecting PM dispersion.The results show that the branch-scale barriers,as porous medium have the ability to interfere with airflow and reduce PM,which could be influenced by wind speed,particle size fraction and surface area density of clove.Moreover,clove elements could adjust to the wind and the micro structure of clove (such as the hierarchical structures of leaves)affected on the PM deposition.These results indicate that the methods developed in this study may be used to evaluate the potential of vegetation in mitigating PM from stationary sources,and some characteristics of vegetation can be further studied as bionic prototype for exploring engineering application of reducing particulates.     

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。     

鼻甲切除术后发生鼻脑毛霉病的诊治——附1例报告

目的 报道1例罕见的继发于鼻甲切除术后的鼻脑毛霉病.临床经过患者为32岁女性,2年前因鼻甲肥厚接受下鼻甲部分切除术.术后3d鼻部皮肤出现红斑,继而出现结节、溃疡.本次就诊的9个月前在门诊取分泌物镜下发现真菌菌丝,考虑为皮肤毛霉病而间断内服伊曲康唑和氟康唑.近半月病情迅速恶化,皮损坏死、发黑并伴剧烈头痛以鼻脑毛霉病收入院治疗.结果 取鼻腔分泌物培养2 d后长出棕褐色絮状菌落.镜下见无囊托的孢子囊,囊梗直立无分支,鉴定为毛霉属真菌.静脉两性霉素B治疗后头痛及皮损改善,但因低钾、心动过缓等副作用被迫停药.患者住院第7 d放弃治疗,后失访.     

美容整形受术者心理研究进展

本文综述了美容整形受术者心理分析及异常心理类型。以及产生异常心理的影响因素。同时也阐述了美容整形受术者心理状态的量化评估和心理防治等方面的研究进展。     

同步厌氧生物脱氮除硫工艺性能的研究

研究了同步厌氧生物脱氮除硫工艺的性能。该工艺具有很高的硫化物和硝酸盐转化潜能,稳态运行时的容积硫化物去除率和容积硝酸盐去除率分别为3.73kg/(m3.d)和0.80kg/(m3.d);能够耐受580mg/L的硫化物浓度和110mg/L的硝酸盐浓度,适宜浓度分别为280mg/L和67.5mg/L;能够耐受较高的水力负荷,适宜的水力停留时间为0.13d,反应器运行性能会因缩短水力停留时间而突发性恶化。     

Fluctuation-driven rhythmogenesis in an excitatory neuronal network with slow adaptation

We study an excitatory all-to-all coupled network of N spiking neurons with synaptically filtered background noise and slow activity-dependent hyperpolarization currents. Such a system exhibits noise-induced burst oscillations over a range of values of the noise strength (variance) and level of cell excitability. Since both of these quantities depend on the rate of background synaptic inputs, we show how noise can provide a mechanism for increasing the robustness of rhythmic bursting and the range of burst frequencies. By exploiting a separation of time scales we also show how the system dynamics can be reduced to low-dimensional mean field equations in the limit N → ∞. Analysis of the bifurcation structure of the mean field equations provides insights into the dynamical mechanisms for initiating and terminating the bursts.     

Phenol biodegradation in hybrid hollow-fiber membrane bioreactors

Hollow-fiber membrane bioreactors were developed with granular activated carbon (GAC) for the biodegradation of phenol using Pseudomonas putida. Hollow fibers showed similar structure with/without GAC incorporated; while GAC hollow fiber had a stronger phenol adsorption capacity. In batch biotransformation experiments, complete depletion of 1000 mg phenol l⁻¹ (at which concentration free cells cannot grow) was accomplished in the reactor within 18 h in the hybrid bioreactor, comparing with 23 h in the GAC free bioreactor. Desorption and bioregeneration of the hollow-fiber membrane were believed to be the key for the enhancement of bioreactor performance. At continuous running, the GAC bioreactor showed its superiority over the GAC free bioreactor during start-up and elevated loading phase. More than 90% of the phenol was transformed in the GAC bioreactor when the phenol loading was <24 mg h⁻¹. The better bioreactor performance may be due to the enhanced mass transportation and adsorption capacity with the incorporation of GAC.