单孔腔镜手术技术专家共识

<正>1背景对于病人而言,外科手术既是一个治疗的过程,又是一个带来创伤(包括生理和心理创伤)的过程。从外科学诞生之日起,创伤、疼痛和瘢痕就始终伴随着外科手术。外科医生也在为最大程度地减轻外科手术对病人造成的生理和心理上的创伤进行着不懈的努力。近年来腹腔镜技     

整数和集的渐近密率

设A和B都是自然数的集合,C是它们的和。A的渐近密率为α。假定B是自然数的一个渐近基底,λ是B的渐近平均阶数。C=A B的渐近密率为γ,得到了用α和λ估计γ的几个定理。     

迎接创意经济新时代

蓦然间，我们已经进入了一个创意经济的新时代。 创意是指另辟蹊径、超越现状、开创新事物。创意不仅仅为个人的发展提供了强大的内在能量，为社会文明的进步奠定了坚实的基础，更是新世纪国家发展的原动力。     

摆动滚子从动件盘形凸轮廓线上任意点的曲率半径——Euler-Savary公式的一个应用

应用Euler-Savary公式导出了摆动滚子从动件盘形凸轮廓线上任意点曲率半径的一个新公式,解决了平面机构啮合理论研究中长期来没有解决的一个难题,新公式不仅可以先于凸轮廓线方程求出廓线上任意点的曲率半径,还找到了曲率半径和压力角之间的内在联系,从而可以置接把强度条件和传力性能结合起来考虑,有利于进一步简化该种凸轮机构的优化设计。     

我爱你，但与你无关

1948年深冬，一个男子在41岁生日那王收到一封厚厚的信．这封信出自一个临死的女人讲述的是一个缠绵的爱情故事，而故事的男主人公却对此一无所知．故事始自18年前，她初遇这个男人的刹那，两人有短暂的结合，而后她经历了少女的痴迷，青春的激情，甚至流落风尘．但未曾改变对这个男人的爱，直至临死前才决定告白……     

不同分化程度人胃癌细胞裸鼠腹腔内种植模型的建立

本文主要应用两种不同分化的人胃癌细胞株SGC7901和MKN45肿瘤悬浮液，制备裸鼠腹腔内种植的动物模型，以期为研究胃癌根治术后肿瘤腹腔内种植提供一个较为可靠、方便的动物模型。     

我和我追逐的梦

大街上满是内衣店,内衣广告也不再避讳人眼,窈窕身段上精致的蕾丝诉说着万语千言。霓虹中,我走过大街,看着女人中的女人朝我微笑。身着寸缕,姿态诱人。可是我知道,这是一个多么温柔的陷阱,那相当于一两件成衣的价格,不是每个人都能承受,也不是每个人都愿意承受的。不     

自体脾腹膜后移植在创伤性脾破裂中的临床应用

目的探讨自体脾组织移植在治疗创伤性脾破裂的应用.方法对本组于2000年1月至2005年4月22例脾破裂行全脾切除后,再行自体脾组织腹膜后移植术.通过检测外周血IgM、IgA、IgG水平和B超,CT、99mTc扫描来观察移植脾片成活和吞噬功能恢复情况.结果术后随访均显示移植脾存活良好,脾功能满意.结论自体脾组织移植可作为严重脾外伤全脾切除术后保留脾功能的一个重要有效手段.     

浅谈医院创新型人才的培养

随着医学科学的高速发展和现代医学模式的转变,创新型人才的培养已成为医院科技发展的关键.医院要想在日趋激烈的市场竞争中抢占制胜点、获取主动权,必须高度重视创新型人才的培养.“创新是民族进步的灵魂,是国家兴旺发达的不竭动力”.要实现建成创新型医院的宏伟目标,必须将培养创新型人才作为医院发展的战略目标和重点[1].本文从以下三方面浅谈医院创新型人才的培养.     

电子计算机在热过程计算中的应用

本文为罐头食品热过程计算发展了一个计算机程序。这个计算机程序使用了一组温度方程和致死率积分公式。由于所使用的温度方程含有两个在罐头工业中最广泛使用的实验参数:j和f值,因此程序使用简便,可靠,而且适用于对流加热和传导加热食品。该程序可用于解决简单型加热食品和有一个转折点的转折型加热食品的两类热过程计算问题。     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Anatomie fonctionnelle du nerf cochléaire et du système auditif central

The auditory pathways are a system of afferent fibers (through the cochlear nerve) and efferent fibers (through the vestibular nerve), which are not limited to a simple information transmitting system but create a veritable integration of the sound stimulus at the different levels, by analyzing its three fundamental elements: frequency (pitch), intensity, and spatial localization of the sound source. From the cochlea to the primary auditory cortex, the auditory fibers are organized anatomically in relation to the characteristic frequency of the sound signal that they transmit (tonotopy). Coding the intensity of the sound signal is based on temporal recruitment (the number of action potentials) and spatial recruitment (the number of inner hair cells recruited near the cell of the frequency that is characteristic of the stimulus). Because of binaural hearing, commissural pathways at each level of the auditory system and integration of the phase shift and the difference in intensity between signals coming from both ears, spatial localization of the sound source is possible. Finally, through the efferent fibers in the vestibular nerve, higher centers exercise control over the activity of the cochlea and adjust the peripheral hearing organ to external sound conditions, thus protecting the auditory system or increasing sensitivity by the attention given to the signal.     

Airway management in obstetrics

Objective

Reviewing problems related to the airway management in obstetrics, taking into account the recent evolutions of the anaesthetic practices in obstetrics.

Data sources

A review of the literature in English and French was performed in the Pumed^® database in April 2010. The first research used the following MeshTerms: “Anesthesia, Obstetrical” [Mesh] AND “Intubation, Intratracheal” [Mesh]. Complementary research used alone or in combination the following keywords: difficult tracheal intubation; failed tracheal intubation; airway; prediction of difficult tracheal intubation; maternal mortality; maternal morbidity; liability; aspiration pneumonia and obstetrical anesthesia.

Study selection

All the publications were retained excluding the correspondence.

Data extraction

Data analysis for the airway management in obstetrics, the prediction of difficult intubation, the prevention of pulmonary inhalation of gastric fluid, but also on maternal morbi-mortality in link with general anesthesia in obstetrics.

Data synthesis

Airway management in obstetrics remains a true challenge for various reasons. The physiological and anatomical modifications related to pregnancy are responsible for a faster hypoxemia, a reduction of the diameter of the pharyngolaryngal tract, as well as an increase of the risk of inhalation of gastric contents after 16 weeks of amenorrhea. The emergency or extreme emergency context and the presence of diseases like obesity or preeclampsia raise the risks of difficulties with airway management. The logical evolution of the practices, with the considerable rise of the regional anesthesia/analgesia limits the training and the maintenance of competences for intratracheal intubation in obstetrics. The training per simulation appears particularly interesting on the subject and this approach needs to be developed. The literature indicates that the incidence of difficult intubation is of one per 30. The impossible intubation is one per 280 in obstetrics, eight times greater than in the general population. No criterion of difficult intubation is sufficiently predictive alone. In obstetrics as in other contexts, the association of several criteria will permit to anticipate a difficult intubation. There is a worsening of the Mallampati during the pregnancy and during labour. To limit the risk of a difficult management of the airway in obstetrics, it will be paramount and capital, in addition to give priority to the regional anaesthesia/analgesia each time possible, to perform a careful and repeated evaluation of the predictive criteria of difficult intubation or ventilation. The inhalation of gastric fluid will systematically be prevented. The adapted material and algorithms for difficult intubation must be available in the labour wards. In case of a difficult intubation during an emergency caesarean section, the SFAR algorithms must be applied. In case of a “cannot intubate can ventilate situation”, the possibility of carrying on the Caesarean maintaining the Sellick manoeuvre should be considered. The place of the laryngoscopy assisted by videolaryngoscope in this context clearly remains to be defined. Even if in the literature some cases of successful intubation through these devices suggest an interest, there is a clear deviance between the guidelines and the practices concerning general anaesthesia performed at the end of the labour. Indeed they should be systematically performed with rapid sequence induction and tracheal intubation. A reflexion on this theme is necessary in order to grant the practices to the recommendations.     

The extracorporeal perfusion of the female pig detrusor as an experimental model for the study of bladder contractility

AIMS: The objective of the study was to establish an experimental model for the extracorporeal perfusion of the pig detrusor. In order to validate this model we examined some biochemical parameters and determined the effect of carbachol on the contractility of perfused female pig bladders. METHODS: Twenty-six pig bladders were perfused with Krebs-Ringer bicarbonate-glucose buffer for a period up to 5 hr with the aim to preserve a viable organ, which would be responsive to contraction-inducing agents. The intravesical pressure of the bladder as well as the intraarterial pressure of the vesical arteries were recorded before and after administration of carbachol. RESULTS: The perfusate pH, lactate, partial carbon dioxide tension, and the ATP content in the perfused tissue, all indicators of tissue ischemia or cell necrosis, showed a good preservation of the organ for up to 5 hr. Carbachol was able to induce contractions of the prefilled bladder with a complete draining of the bladder throughout the whole perfusion period. CONCLUSIONS: We could demonstrate that this perfusion system was able to preserve the pig bladder in a functional condition, appropriate for the study of physiological questions.     

胫骨高位截骨术后髌骨低位

目的探讨胫骨高位截骨术治疗膝关节内侧间室骨性关节炎后髌骨低位与胫骨近端关节面后倾角度改变之间的关系,并提出预防和控制髌骨低位的措施。方法41例(48膝)膝关节内侧间隙骨性关节炎患者,男30例(33膝),女11例(15膝);年龄45～56岁,平均52岁。所有病例均行胫骨外侧高位楔形截骨术。根据术前测量的截骨角度(内翻角+正常外翻角+过度矫形3°～5°),在槽刀和导向器等辅助下切除楔形骨块,用改良Giebel槽式钢板拉力螺钉内固定,术后不需外固定。测量48膝行胫骨高位截骨术患者术前及术后X线片的Insall-Salvati比值、胫骨近端关节面后倾角度、胫骨结节高度、患肢解剖轴线角度,并用χ2检验和直线回归分析进行统计学处理。检验时假定术后胫骨近端关节面后倾角度减小≥5°以及髌骨高度下降≥10%具有临床意义。结果术后胫骨近端关节面后倾角度比术前平均减小6.14°,Insall-Salvati比值术前、术后相对变化率为10.6%,胫骨结节高度比术前平均下降3.13mm。64.6%的病例胫骨近端关节面后倾角度减小≥5°。按Insall-Salvati比值结果,56.2%的病例髌骨高度相对下降率≥10%。胫骨近端关节面后倾角度的减小与髌骨高度的相对下降具有显著的统计学相关性。结论胫骨近端关节面后倾角度的减小与髌骨低位具有相关性,提示在施行胫骨高     

One‐Health Simulation Modelling: Assessment of Control Strategies Against the Spread of Influenza between Swine and Human Populations Using NAADSM

Simulation models implemented using a range of parameters offer a useful approach to identifying effective disease intervention strategies. The objective of this study was to investigate the effects of key control strategies to mitigate the simultaneous spread of influenza among and between swine and human populations. We used the pandemic H1N1 2009 virus as a case study. The study population included swine herds (488 herds) and households‐of‐people (29 707 households) within a county in Ontario, Canada. Households were categorized as: (i) rural households with swine workers, (ii) rural households without swine workers and (iii) urban households without swine workers. Seventy‐two scenarios were investigated based on a combination of the parameters of speed of detection and control strategies, such as quarantine strategy, effectiveness of movement restriction and ring vaccination strategy, all assessed at three levels of transmissibility of the virus at the swine–human interface. Results showed that the speed of detection of the infected units combined with the quarantine strategy had the largest impact on the duration and size of outbreaks. A combination of fast to moderate speed of the detection (where infected units were detected within 5–10 days since first infection) and quarantine of the detected units alone contained the outbreak within the swine population in most of the simulated outbreaks. Ring vaccination had no added beneficial effect. In conclusion, our study suggests that the early detection (and therefore effective surveillance) and effective quarantine had the largest impact in the control of the influenza spread, consistent with earlier studies. To our knowledge, no study had previously assessed the impact of the combination of different intervention strategies involving the simultaneous spread of influenza between swine and human populations.     

Baropodometric analysis of the functional donor-site morbidity after gastrocnemius or soleus muscle-flap procedure

The triceps surae muscle is a major donor-site for muscle-flap to cover soft-tissue defects of the leg. There are very limited datas on the functional donor-site morbidity in the literature. From a retrospective study on 14 patients, we realized a baropodometric analysis comparing the operated lower limb with the healthy non operated side and a functional evaluation by a questionary. The modified functional score of Kitatoka was good (87/100). Ninety percent of the patients were able to resume a professional activity and 2/3 to resume the sport. The baropodometric analysis did not show statistically significant difference of propulsion and absorption between the healthy side and the operated side, but a modification of the programming of the step. The absence of important functional donor-site morbidity is probably bound to a compensation of the remaining triceps surae muscles and/or to mechanisms of adaptation. Our study confirms the little functional donor-site morbidity of the partial triceps surae muscle-flap procedure. These flaps remain a good solution for the coverage of the soft-tissue defects of the leg.     

Phénotypage métabolique par résonance magnétique nucléaire pour l’évaluation périopératoire et en réanimation

Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. This approach allows the extraction of candidate biomarkers and the recovery of perturbed metabolic networks, driving to the generation of biochemical hypotheses (pathophysiological mechanisms, diagnostic tests, therapeutic targets…). Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults.