封场生活垃圾填埋场好氧治理通风系统计算与应用

从质量守恒定律出发,以Buswell提出的垃圾好氧降解反应方程式为基础,建立了计算通风量的化学计量模型;以达西定律为基础,建立了计算通风压力的数学模型;并将其应用于某封场垃圾填埋场原位好氧治理工程的计算,验证了2个模型的合理性和准确性,可为生活垃圾填埋场好氧生物反应器工艺设计和设备选型提供理论数据参考。     

Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review

Abstract

Background and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes.

Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled.

Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p?<?.001) and capsules retained in the ileum (41/41 [100.0%] vs. 43/58 [74.1%], p?<?.001) or trapped by benign strictures (21/21 [100.0%] vs. 65/83 [78.3%], p?=?.043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p?=?.002).

Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures.     

Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children.

BACKGROUND: The validity of parent reports regarding children's attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned. This study assessed whether parent reports were as sensitive as teacher reports to document change in ADHD symptoms during clinical trials with atomoxetine. METHODS: Data were compared from two randomized, double-blind, placebo-controlled clinical trials of atomoxetine using different versions (parent or teacher) of the same rating scale (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV [parent or teacher] Version: Investigator Administered and Scored - ADHD RS). Exclusion criteria included history of bipolar disorder, psychosis, seizures, alcohol abuse, or positive drug screen. Patients (6-16 years old) were treated with atomoxetine (titrated to a maximum dose of 1.8 mg/kg/day) administered once daily for up to 7 weeks. Parent and teacher ratings were compared using an analysis of covariance (ANCOVA) model. RESULTS: The analysis (n = 318) showed that treatment effects (mean change, baseline to endpoint) were similar between parent and teacher ratings (total, p = .762; inattention, p = .519; hyperactive/impulsive, p = .955). Effect sizes also were similar based on total scores (parent ratings = .69; teacher ratings = .63). CONCLUSIONS: Parent reports are as sensitive as teacher reports in assessing the efficacy of long-acting pharmacologic treatment for ADHD in children during clinical trials using the nonstimulant atomoxetine.     

透析液钙离子浓度对肾功能衰竭血液透析患者血清钙离子水平及血压的影响

目的 观察不同钙离子浓度的透析液对血液透析患者透析后血清钙离子水平及血压变化的影响，为肾功能衰竭血液透析患者的高钙血症及高血压的防治提供依据。方法 选择不同钙离子浓度的透析液，将维持性血液透析患者分为高钙组（1．75mmol／L）和低钙组（1．25mmol／L），比较患者每次透析前后脉搏、血压，同时抽查患者透析前后血钙及血肌酐浓度的变化。结果透析后两组患者血肌酐浓度均显著下降，透析前后差异均具有统计学意义（P〈0．01）；高钙组患者透析后血钙较透析前升高，差异具有统计学意义（P〈0．01），而低钙组患者血钙比透析前略降低，差异无统计学意义（P〉0．05）。高钙组患者透析后较透析前收缩压、舒张压及平均动脉压都升高，差异均具有统计学意义（P〈0．05），而低钙组患者透析后较透析前收缩压、舒张压及平均动脉压都降低，差异均具有统计学意义（P〈0．05）。透析后两组血钙比较差异具有统计学意义（P〈0．01）；透析后低钙组较高钙组患者的收缩压、舒张压及平均动脉压都降低，三者差异均具有统计学意义（P〈0．01）。结论透析液钙离子浓度与血液透析患者血清钙离子水平及血压呈正相关，低钙透析液透析有助于维持性血液透析患者高血压的控制。     

医学插图的艺术创作

介绍了医学插图艺术创作的方法:即在依据医学科学内容的基础上,遵循美学规律,运用科学的艺术表现形式,准确、形象、生动地表达出医学科学的深刻内涵,从而实现医学科学与艺术完美结合的创作目标。     

胶囊内镜检查对双气囊小肠镜进镜方式选择的指导作用

目的:探讨胶囊内镜检查对双气囊小肠镜进镜方式选择的指导作用．方法:胶囊内镜检查阴性或可疑病变者20例行双气囊小肠镜检查(均在麻醉下进行),包括经口和经肛进镜方式．根据胶囊内镜时间指数 (胶囊内镜从幽门至病灶的通过时间／幽门至回盲瓣的通过时间)选择首次进镜方式,时间指数>0．50时首先考虑经肛进镜检查,对未发现异常者择期改换方式再行检查．分析按胶囊内镜时间指数选择双气囊小肠镜进镜方式的准确性．结果:胶囊内镜检查阴性者5例,行经口双气囊小肠镜检查,有1例在改为经肛检查后检出病灶．胶囊内镜检查怀疑小肠病变者15例,有 12例(80．0％)经双气囊小肠镜结合活检病理确诊．以时间指数>0．50为标准,4例(分别为0．99, 0．8,0．65和0．59)首选经肛进镜检查,后二者(时间指数分别为0．65和0．59)需换从口侧进镜检查而检出病灶;如以时间指数>0．75为标准,该 2例不再需要改换方式再行检查,另2例病变部位被判断为回肠远端,经肛进镜即可准确到达病灶．结论:胶囊内镜检查可指导对双气囊小肠镜进镜方式的选择,时间指数>0．75提示首选经肛进镜检查．     

Modified superficial parotidectomy: preserving both the great auricular nerve and the parotid gland fascia.

OBJECTIVE: To reduce the incidence of sensory deficits and Frey's syndrome by modifying the traditional superficial parotidectomy. STUDY DESIGN: After raising the skin flap, the parotid gland fascia (PGF) was elevated to form a posterior pedicle fascial flap and then was replaced after the gland removal. The great auricular nerve (GAN) that runs within the PGF was not separated, so both the GAN and the PGF were preserved. Before this modification, the GAN and PGF were examined anatomically. The complication rates in the modified and control groups were compared. RESULTS: 1) The GAN, which runs within the thick and pycnotic PGF, trifurcates into postauricular, preauricular and lobule branches. The modification could be carried out practically based on the anatomy study. 2) Long-term sensory deficit was encountered in 13.3% of the control group, but 0% in the modified one. Frey's syndrome was suffered by 66.7% and 16.7% cases in the control and modified group respectively. The incidence of other complications was not significantly different. CONCLUSION: Our modification is practical. It decreases the complications significantly. EBM rating: B-3b.     

暗纹节菱孢所致皮肤真菌病组织病理学及超微结构观察

本文报告了暗纹节菱孢[Arthinium phaeospemum（Corda）Ellis]所致皮肤真菌病的组织病理学及超微结构观察。HE、PAS、镀银染色（Szatri）法及铅铀染色，对皮损的组织病理改变，进行了光镜及透射电镜观察。光镜下发现暗纹节菱孢引起真皮及皮下脂肪组织广泛性病理浸润，由多种细胞构成的肉芽肿，尤其对皮肤附属器严重破坏。在病理浸润中可见球形、卵圆形、菱形及晶体形，玫瑰红色、棕色及褐色孢子。透射电镜下见真皮成纤维细胞胞浆内吞噬多数界线清楚的圆形小体，空泡内也有相同的小体，胞浆空泡甚多，胞核完整。同时见到破坏的溶酶体。病理浸润内形态各异的孢子及不同颜色，是孢子生长的不同阶段。     

Efficacy and safety of herbal medicines for idiopathic Parkinson's disease: a systematic review.

The objective of this study is to assess the efficacy and safety of herbal medicines (HMs), as a monotherapy or adjunct therapy, compared to placebo or conventional approaches in the treatment of idiopathic Parkinson's disease (PD). We conducted a systematic review of randomized controlled trials from both conventional and alternative medicine sources. Outcome measures were overall improvement, quality of life, reduction of levodopa dose, and adverse events. Nine studies were included, each testing a different HM. Six of the trials had limited internal validity due to major flaws in design, including the lack of proper randomization; insufficient blinding; unclear inclusive criteria in terms of diagnostic criteria, baseline staging, and duration of disease; lack of proper sample size calculation; and insufficient data analysis. Imbalances in gender and ethnicity among the patients in the included trials were observed. No major adverse events emerged, and no specific pattern was detected from the trials describing such data. In addition to major methodological defects, heterogeneity in (1) HM tested, (2) control treatment, and (3) outcome measure hindered in-depth data analysis and synthesis. Current evidence is insufficient to evaluate the efficacy and safety of various HMs. Further studies with improved trial design and reporting, with assessment on cost-effectiveness, quality of life, and qualitative data are warranted.     

广龙昊膏药对大鼠腰椎间盘突出模型细胞因子IL-1、NO及组织胺的影响

为探讨IL-1、NO及组织胺在腰椎间盘突出中的作用及广龙昊膏药的治疗效果，将60只大鼠造模并随机分为正常组（A组）、造模组（B组）、广龙昊膏药组（C组）和奇正止痛膏组（D组），观察其神经根周围局部组织中IL-1、NO及组织胺的含量。结果显示，B组中的IL-1、NO及组织胺较A组显著升高（P〈0．01）。C组、D组较B组明显下降（P〈0．01）。表明大鼠腰椎间盘突出模型中细胞因子IL-1、NO及组织胺明显增加可能是腰椎间盘突出中的潜在始动或促进因素，而C组能显著降低神经根局部中IL-1、NO及组织胺的含量，说明广龙昊膏药作用部分是通过抑制炎性细胞因子的活性实现的。