结肠在平卧位经皮肾穿刺造瘘中损伤的影像解剖学研究

目的探讨平卧位经皮肾穿刺结肠损伤的机制和几率,为临床经皮肾镜手术提供理论指导。方法对412例平卧位腹部CT进行回顾性分析,模拟一条自腰椎前切缘分别经过肾上极、肾门、肾下极的穿刺线,将升、降结肠位置分为穿刺线前、线后或线上,前者定义为无潜在损伤风险,后两者定义为有潜在损伤风险,从影像学、解剖学上分析平卧位经皮肾穿刺结肠损伤的机制和概率。结果经左侧肾上极、肾门、肾下极的穿刺中结肠有潜在损伤风险的分别为0例、0例、3例（0.73%）;右侧肾上极、肾门、肾下极的穿刺中无1例有潜在损伤风险。结论平卧位行经皮肾穿刺结肠损伤发生机率低,但经皮肾镜术前最好常规行CT检查了解解剖变异,以避免结肠损伤严重并发症的发生。     

亚低温对急性肺损伤肺保护作用的临床研究

目的探讨亚低温对急性肺损伤(ALI)肺保护作用及机制。方法 97例ALI随机分为亚低温组和对照组,呼吸末气道闭合法评估肺顺应性变化,监测机体氧和,测定肺局部IL-6及血浆降钙素原(PCT),统计机械通气时间及参数变化。结果与对照组相比,亚低温组机械通气时间缩短,呼吸机支持力度下降,肺局部IL-6及PCT下降,肺顺应性、动脉血氧分压提高,肺泡-动脉氧分压差下降,肺功能改善,差异有统计学意义(P<0.05)。结论亚低温可保护ALI患者肺功能,与强化抗炎、改善氧和等有关。     

围术期离床锻炼联合呼吸训练对股骨颈骨折老年患者肺功能和PSQI评分的意义

股骨颈骨折是发生在股骨头至股骨颈基底部之间的一种骨折类型,主要表现为下肢活动受限,髋部疼痛,无法站立、行走[1?2].股骨颈骨折多与老年人骨质量下降有关,在轻微扭转引发的间接暴力作用下发生[3].临床上治疗股骨颈骨折的主要方法是进行外科手术,老年患者多存在自身疾病,加之衰老引起的器官生理构造改变、生理功能衰退等原因,老...     

Human influenza A (H5N1) cases, urban areas of People's Republic of China, 2005-2006

We investigated potential sources of infection for 6 confirmed influenza A (H5N1) patients who resided in urban areas of People's Republic of China. None had known exposure to sick poultry or poultry that died from illness, but all had visited wet poultry markets before illness.     

Unraveling the Phase Stability and Physical Property of Modulated Martensite in Ni2Mn1.5In0.5 Alloys by First-Principles Calculations

Large magnetic field-induced strains can be achieved in modulated martensite for Ni-Mn-In alloys; however, the metastability of the modulated martensite imposes serious constraints on the ability of these alloys to serve as promising sensor and actuator materials. The phase stability, magnetic properties, and electronic structure of the modulated martensite in the Ni₂Mn_1.5In_0.5 alloy are systematically investigated. Results show that the 6M and 5M martensites are metastable and will eventually transform to the NM martensite with the lowest total energy in the Ni₂Mn_1.5In_0.5 alloy. The physical properties of the incommensurate 7M modulated martensite (7M–IC) and nanotwinned 7M martensite (7M−(52¯)2) are also calculated. The austenite (A) and 7M−(52¯)2 phases are ferromagnetic (FM), whereas the 5M, 6M, and NM martensites are ferrimagnetic (FIM), and the FM coexists with the FIM state in the 7M–IC martensite. The calculated electronic structure demonstrates that the splitting of Jahn–Teller effect and the strong Ni–Mn bonding interaction lead to the enhancement of structural stability.     

Restirring and Reheating Effects on Microstructural Evolution of Al–Zn–Mg–Cu Alloy during Underwater Friction Stir Additive Manufacturing

Friction stir additive manufacturing (FSAM) can be potentially used for fabricating high-performance components owing to its advantages of solid-state processing. However, the inhomogeneous microstructures and mechanical properties of the build attributed to the complex process involving restirring and reheating deserve attention. This study is based on the previous research of the underwater FSAMed 7A04 aluminum alloy and adopts a quasi in situ experimental method, i.e., after each pass of the underwater FSAM, samples were taken from the build for microstructural observation to investigate the restirring and reheating effects on microstructural evolution during the underwater FSAM. Fine-grain microstructures were formed in the stir zone during the single-pass underwater FSAM. After restirring, the grain size at the bottom of the overlapping region decreased from 1.97 to 0.87 μm, the recrystallization degree reduced from 74.0% to 29.8%, and the initial random texture transformed into a strong shear texture composed of the C {110}<11¯0>. After reheating, static recrystallization occurred in the regions close to the new additive zones, increasing the grain size and recrystallization degree. This study not only revealed the microstructural evolution during the underwater FSAM but also provided a guideline for further optimization of the mechanical properties of the Al–Zn–Mg–Cu alloy build.     

探讨ICU获得性肺部感染的病因分析

目的探讨ICU院内获得性肺部感染的病因。方法183例危重病患者均来自于2004年1月~2006年4月入住怀化医学高等专科学校附属医院暨怀化市第三人民医院ICU的患者。结果183例危重病患者中发生院内获得性肺部感染47例,感染率25.68%。年龄愈大、住院时间愈长、采用手术治疗、气管插管或切开的患者,肺部感染率愈高。结论ICU院内获得性肺部感染率较高,应引起临床医务人员的高度重视。     

MAGE-A3基因与MDR1基因在非M3型急性白血病患者中的表达及其临床意义

目的观察MAGE-A3与MDR1在非M3型急性白血病（AL）患者中的表达及其与治疗反应的关系。方法应用逆转录-聚合酶链反应法观察77例初治非M3型AL患者MAGE-A3和MDR1的表达,结合临床观察。结果MAGE-A3及MDR1在非M3型AL患者中表达阳性率分别为50．6％与23．3％。MAGE-A3表达阳性与阴性者MDR1阳性率分别为46．2％与13．2％（P〈0．01）。MAGE-A3表达阴性与阳性者治疗完全缓解（CR）率分别为86．8％与64．1％（P〈0．05）;MDR1表达阴性与阳性者CR率分别为83．3％与56．5％（P〈0．05）。MAGE-A3和MDR1表达均为阳性者与均为阴性CR率分别为55．6％与87．9％（P〈0．05）。结论非M3型AL MAGE-A3表达阳性者MDRI有较高的表达率,MAGE-A3及MDR1表达均为阴性者治疗缓解率高。提示联合检测MAGE,A3和MDR1对判断初治非M3型AL的疗效有良好的预测作用,可作为临床判断疗效的一项有意义的指标。     

上海世博会园区内伤害流行病学特征分析

[目的]了解中国2010年上海世博会（简称“上海世博会”）园区内伤害流行病学特征。[方法]利用“中国2010年上海世界博览会园区内就诊异常情况监测和报告系统”（后称“就诊监测报告系统”）,观察上海世博会园区内伤害病例,对其伤害原因、伤害性质等流行病学特征进行调查分析。[结果]从2010年5月1日至10月31日,伤害监测系统共收集12505例伤害病例。5月份游客伤害发生率最高（月均3．01／万）,在世博局采取健康宣教以及改善园区内设施等一系列干预措施后,游客伤害发生率逐步下降,从5月初的4．50／万降低到最后一周的0．80／万。伤害分别是≥65岁和0～14岁游客的第1和第3位就诊原因。游客的主要伤害原因是跌倒和坠落。但是园区内最主要的伤害性质是挫伤和擦伤。[结论]上海世博会园区内伤害发生特征表明,在大型活动中,及时进行健康干预能有效地降低伤害的发生。     

Initial satisfying experience of total retroperitoneal laparoscopic radical nephroureterectomy: a retrospective comparative research

BackgroundRadical nephroureterectomy (RNU) is the principal method for treatment of high-risk upper urinary tract urothelial carcinoma (UTUC). The transperitoneal approach is associated with poor disease progression, but the distal ureter-bladder cuff (DUBC) resection through retroperitoneal laparoscopic approach is difficult. This study proposed a modulated RNU technique, namely, total retroperitoneal laparoscopic radical nephroureterectomy (tRLRNU), with its advantages of DUBC resection and requiring fewer trocars etc. The efficiency, safety, and short-term impacts were retrospectively compared with total transperitoneal laparoscopic radical nephroureterectomy (tTLRNU).MethodsTotal of 12 patients who received tRLRNU and 28 patients who received tTLRNU were enrolled. The choice of surgical approach was random and their data were retrospectively analyzed. During tRLRNU, the laparoscope was versed towards the caudal direction and a retroperitoneal laparoscopic ureterectomy was performed. The bladder cuff was entirely transected and the bladder incision was sutured. The tRLRNU cases were compared with the tTLRNU cases in terms of general clinical data, pathologic parameters, peri-operative parameters, adjuvant therapy, and short-term outcomes. The independent samples t-tests, chi-square tests, and Fischer exact tests were used to analyze the differences.ResultsThere were no significant differences in the basic patient characteristics between the 2 groups. The data were comparable. There were significantly fewer trocars utilized in tRLRNU group compared to tTLRNU group (P=0.0008). tRLRNU group experienced less blood loss (98.33±61.32 versus 170.71±121.32 mL; P=0.017), smaller drainage volume (182.08±163.60 versus 1,924.82±3,370.02 mL; P=0.011), and shorter extubation time (5.67±1.07 versus 8.57±6.96 days; P=0.040) compared to tRLRNU group. There were no statistically differences in the other peri-operative parameters, including whole operation time, transfusion, visceral and vascular injuries, open conversion, post-operative bleeding, recovery time of intestinal function, and discharge time. The patient outcomes in tTLRNU group at 6 months were significantly worse than that of tRLRNU group by comparing progression-free survival, progression survival and mortality (P=0.039).ConclusionsThe tRLRNU was potentially safer, minimally invasive, and more effective compared to the tTLRNU. Due to the small sample size, short follow-up time and no randomization of the study, future comparative studies are warranted to further analyze long-term outcomes of tRLRNU.