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。     

Glucose uptake of Cytophaga johnsonae studied in batch and chemostat culture

The influence of different physiological states on the glucose uptake and mineralization by Cytophaga johnsonae, a freshwater isolate, was examined in batch and chemostat cultures. At different growth rates under glucose limitation in chemostat cultures, different uptake patterns for ¹⁴C labeled glucose were observed. In batch culture and at high growth rates the glucose uptake potential showed a higher maximum velocity and a much lower substrate affinity than at lower growth rates. These findings and the results of short-term labeling patterns could be explained by two different glucose uptake mechanisms which enable the strain to grow efficiently both at high and low substrate concentrations. Substrate specificity studies showed that a structural change of the C-2 atom of the glucose molecule was tolerated by both systems. The consequences of these results for the ecophysiological classification of the Cytophaga group and for the operation of continuous cultures are discussed.     

黑龙江省辖区内“120”急救中心调度员工作量及职业压力现状研究

目的:调查黑龙江省辖区内的120急救调度中心调度员的工作量与职业压力情况,为在120急救中心进行人力资源优化配置提供支持。方法:通过基础工作量问卷与工作内容量表(JCQ)问卷对黑龙江省内8家"120"急救调度中心内共计62名急救中心调度员进行调查和统计分析,并对调度科室主任进行访谈。结果:调度员的通话量呈现明显的地区差异性并异常地高于调度量,调度员的工作属于积极型的工作状态,但是决策自主度的分数较低,而技术自主度则与通话量和调度量具有明显线性关系(P0.05),调度时间与上司支持和同事支持有显著相关性(P0.05)。结论:黑龙江省辖区内的急救调度中心依旧处于组织结构复杂化、资源分配不均的情况,需要对调度员缩短调度时间进行训练以及对市民进行急救知识教育以减少无用通话的数量。     

THE YANGTZE RIVER-FLOODPLAIN ECOSYSTEM: MULTIPLE THREATS AND HOLISTIC CONSERVATION北大核心CSCD

The Yangtze (Changjiang) river-floodplain is one of the most important ecosystems in China and the world, but is seriously threatened by multiple stresses. Thus, it is crucial and urgent to rehabilitate and conserve the river-floodplain. This paper reviews ecological studies conducted on the Yangtze river-floodplain, and presents suggestions for conservation and rehabilitation. First, basic concepts and research advances of riverscape and hydrological connectivity are introduced. Second, the history and current status of the Yangtze River system are summarized. Before 23 Ma, the Yangtze River cut through the Three Gorges, forming the river much like the modern one. Numerous rivers, streams, lakes (the total area 15770 km2 at present) and wetlands are distributed in the mid-lower Yangtze river-flood-plain. Such a river-lake complex ecosystem holds a unique and diverse biota, and is the most important fishery area of China. Third, main threats to the Yangtze river-floodplain ecosystem are identified, i.e., a) habitat loss, including river channelization, sharp shrinkage of lake area (ca. 10000 km2 since the 1950s), degradation of lakeshore zones and sand over-mining; b) alternations of hydrological regimes, including construction of ca. 47000 reservoirs and disconnection of most lakes from the mainstem; c) water pollution, including eutrophication, heavy metals, organic pollutants and microplastic; d) overexploitation of biological resources, including overfishing and intensive pen culture. Fourth, effects of river-lake disconnection on lake ecosystems are summarized. It was found that a) disconnection is one of the main causes of lake eutrophication; b) species diversity, biomass, production of macrophytes and macrobenthos reach maxima at some levels of intermediate river connectivity; c) disconnection greatly reduces fish species richness of each habitat guild, and natural fish larvae is severely depleted; d) disconnection simplifies macroinvertebrate food web structure, and trophic basis is more heavily relied on detritus in disconnected lakes. Last, conservation strategies are proposed. Since the Yangtze river-floodplain is a huge integrated system, the biodiversity conservation must be conducted on the whole basin scale. By establishing species-area models of fishes, the minimum protected area of Yangtze-connected lakes is estimated to be ca. 14400 km2. It means that at least 8900 km2 of disconnected lakes should be reconnected with the Yangtze mainstem, and ecohydrological operation of dams and sluices is the feasible approach. Based upon our studies on environmental flow requirements, the following measures are suggested: a) lower water levels during spring to improve germination of macrophytes, and control rising rates of water levels during spring-summer to ensure development of macrophytes; b) open sluice gates to restore migration routes for juveniles migrating into lakes during April-September, and for adults migrating back to the Yangtze mainstem during November-December. © 2019, Institute of Hydrobiology, Chinese Academy of Sciences. All rights reserved.     

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。     

Ⅰ、Ⅱ期乳腺癌行保乳术的近期疗效观察

目的探讨Ⅰ、Ⅱ期乳腺癌行保乳术的近期疗效。方法选择2014年8月~2016年4月我院收治的Ⅰ、Ⅱ期乳腺癌患者104例为研究对象,依据患者治疗方法的不同分为治疗组和对照组各52例,对照组实施改良根治术治疗,治疗组实施保乳术治疗,观察比较两组患者近期疗效。结果治疗组平均手术时间、术中出血量以及住院时间均明显少于对照组(P0.05);而且治疗组术后乳房美容效果优良率达94.2%,对照组为76.9%,两组比较差异有统计学意义(P0.05);两组病灶局部复发和转移情况比较,差异无统计学意义(P0.05)。结论早期乳癌患者接受保乳术治疗具有显著疗效,病灶局部复发与转移发生率小,而且患者乳房外形良好,达到美学标准,值得临床推广。     

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。     

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。     

腔内大量盐水灌洗辅助取出乳房内聚丙烯酰胺水凝胶临床应用

目的：探讨聚丙烯酰胺水凝胶注射隆胸后取出新方法.方法：对48例注射聚丙烯酰胺水凝胶隆胸患者术前行双乳MRI或彩超检查结合触诊准确定位.全麻小切口开放直视下吸出水凝胶,再用大量生理盐水反复灌洗所有腔隙,直至手感探测不到硬结,盐水中无水凝胶为止.结果：48例患者术后无继发感染和出血等并发症.术前诸症状体征消失,无明显乳房变形,乳房形态术后恢复满意.术后双乳MRI复查未见明显异物残留.术后1 ～12月（6.2±0.3月）45例随访复查MRI亦未见异物残留,乳房修复完好.结论：注射隆乳后腔内大量盐水灌洗辅助取出水凝胶具有创伤小、出血少、操作简单、费用低廉的优点,是一种较好的、值得推广的凝胶取出术式.     

Stanford A型主动脉夹层孙氏手术患者术后血流感染的影响因素及术前PCT、IL-6、D-D的预测价值研究

摘要 目的：分析Stanford A型主动脉夹层（AD）孙氏手术患者术后血流感染（BSI）的影响因素,并探讨术前血清降钙素原（PCT）、白细胞介素-6（IL-6）、D-二聚体（D-D）对术后发生BSI的预测价值。方法：选取2019年1月～2022年1月贵州医科大学附属医院收治的236例接受孙氏手术的Stanford A型AD患者,根据术后是否BSI分为BSI组和非BSI组。收集患者基础资料和实验室指标,采用多因素Logistic回归分析Stanford A型AD孙氏手术患者术后发生BSI的影响因素,采用受试者工作特征（ROC）曲线分析血清PCT、IL-6、D-D水平对Stanford A型AD孙氏手术患者术后发生BSI的预测价值。结果：BSI组年龄≥60岁、糖尿病史、机械通气、气管切开、人工瓣膜植入比例和术后24 h引流量、血清C反应蛋白、PCT、IL-6、D-D水平高于非BSI组,手术时间、心包纵隔管保留时间长于非BSI组（P＜0.05）。多因素Logistic回归分析显示,年龄≥60岁、糖尿病史、机械通气、气管切开、术后24 h引流量上升,血清PCT、IL-6、D-D水平上升为Stanford A型AD孙氏手术患者术后发生BSI的危险因素（P＜0.05）。ROC曲线分析显示,血清PCT、IL-6、D-D三项联合预测的Stanford A型AD孙氏手术患者术后发生BSI的曲线下面积大于单独预测。结论：年龄、糖尿病史、机械通气、气管切开、术后24 h引流量、血清PCT、IL-6、D-D水平是Stanford A型AD孙氏手术患者术后发生BSI的影响因素,术前血清PCT、IL-6、D-D水平可作为Stanford A型AD孙氏手术患者术后发生BSI的辅助预测指标。